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Kay AC, Wells J, Goriely A, Hallowell N. Professionals' views on providing personalized recurrence risks for de novo mutations: Implications for genetic counseling. J Genet Couns 2024. [PMID: 38924179 DOI: 10.1002/jgc4.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/28/2024]
Abstract
When an apparent de novo (new) genetic change has been identified as the cause of a serious genetic condition in a child, many couples would like to know the risk of this happening again in a future pregnancy. Current practice provides families with a population average risk of 1%-2%. However, this figure is not accurate for any specific couple, and yet, they are asked to make decisions about having another child and/or whether to have prenatal testing. The PREcision Genetic Counseling And REproduction (PREGCARE) study is a new personalized assessment strategy that refines a couple's recurrence risk prior to a new pregnancy, by analyzing several samples from the parent-child trio (blood, saliva, swabs, and father's sperm) using deep sequencing and haplotyping. Overall, this approach can reassure ~2/3 of couples who have a negligible (<0.1%) recurrence risk and focus support on those at higher risk (i.e. when mosaicism is identified in one of the parents). Here we present a qualitative interview study with UK clinical genetics professionals (n = 20), which investigate the potential implications of introducing such a strategy in genetics clinics. While thematic analysis of the interviews indicated perceived clinical utility, it also indicates a need to prepare couples for the psychosocial implications of parent-of-origin information and to support their understanding of the assessment being offered. When dealing with personalized reproductive risk, a traditional non-directive approach may not meet the needs of practitioner and client(s) and shared decision-making provides an additional framework that may relieve some patient burden. Further qualitative investigation with couples is planned.
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Affiliation(s)
- Alison C Kay
- MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
- The Centre for Personalised Medicine, University of Oxford, Oxford, UK
| | - Jonathan Wells
- MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
- Clinical Genetics, St. Michael's Hospital, Bristol, UK
| | - Anne Goriely
- MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - Nina Hallowell
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Kay AC, Wells J, Hallowell N, Goriely A. Providing recurrence risk counselling for parents after diagnosis of a serious genetic condition caused by an apparently de novo mutation in their child: a qualitative investigation of the PREGCARE strategy with UK clinical genetics practitioners. J Med Genet 2023; 60:925-931. [PMID: 36931705 PMCID: PMC10447403 DOI: 10.1136/jmg-2023-109183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Diagnosis of a child with a genetic condition leads to parents asking whether there is a risk the condition could occur again with future pregnancies. If the cause is identified as an apparent de novo mutation (DNM), couples are currently given a generic, population average, recurrence risk of ~1%-2%, depending on the condition. Although DNMs usually arise as one-off events, they can also originate through the process of mosaicism in either parent; in this instance, the DNM is present in multiple germ cells and the actual recurrence risk could theoretically be as high as 50%. METHODS Our qualitative interview study examined the views and reflections on current practice provided by UK practitioners working in clinical genetics (n=20) regarding the potential impact of PREcision Genetic Counselling And REproduction (PREGCARE)-a new preconception personalised recurrence risk assessment strategy. RESULTS Those interviewed regarded PREGCARE as a very useful addition to risk management, especially for cases where it revised the risk downwards or clarified that a couple's personalised recurrence risk meets National Health Service thresholds for non-invasive prenatal testing, otherwise inaccessible based on the generic DNM recurrence risk. CONCLUSION Participants said it could release some couples requiring reassurance from undergoing unnecessary invasive testing in future pregnancies. However, they regarded mosaicism and PREGCARE as complex concepts to communicate, requiring further training and additional appointment time for pre-test genetic counselling to prepare couples for all the possible outcomes of a personalised risk assessment, including potentially identifying the parental origin of the DNM, and to ensure informed consent.
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Affiliation(s)
- Alison C Kay
- MRC-Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jonathan Wells
- MRC-Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nina Hallowell
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Goriely
- MRC-Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Bowman-Smart H, Gyngell C, Mand C, Amor DJ, Delatycki MB, Savulescu J. Non-Invasive Prenatal Testing for "Non-Medical" Traits: Ensuring Consistency in Ethical Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:3-20. [PMID: 34846986 PMCID: PMC7614328 DOI: 10.1080/15265161.2021.1996659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including "non-medical" traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as "non-medical"; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework.
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Affiliation(s)
- Hilary Bowman-Smart
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Corresponding author: Hilary Bowman-Smart Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville Victoria Australia 3052, , (03) 8341 6200
| | - Christopher Gyngell
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
| | - Cara Mand
- Murdoch Children’s Research Institute, Parkville, Australia
| | - David J. Amor
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Martin B. Delatycki
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Julian Savulescu
- Murdoch Children’s Research Institute, Parkville, Australia
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
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Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, de Jonge A. Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS One 2020; 15:e0234252. [PMID: 32511258 PMCID: PMC7279596 DOI: 10.1371/journal.pone.0234252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annika Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lianne Holten
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - François Schellevis
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gagnon R. L’enfant à naître : dispositifs de
contrôle dès que la vie paraît. ENFANCES, FAMILLES, GÉNÉRATIONS 2020. [DOI: 10.7202/1067816ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cadre de la recherche : L’article met en
lumière l’influence des technologies et de la médicalisation, dès la vie
utérine, sur les femmes ayant une grossesse dite normale.
Objectifs : L’objectif est de démontrer
comment le politique, les institutions et la société mettent en place des
dispositifs permettant d’assurer un contrôle sur le fœtus à travers le corps de
la mère et comment ceux-ci modifient le rapport à la grossesse et le
développement de la relation anténatale.
Méthodologie : Une recherche qualitative
avec une approche phénoménologique contextualisée a permis de recueillir les
propos de vingt-cinq primipares québécoises sur leur expérience lors de la
grossesse et après la naissance de l’enfant. L’analyse a été conduite dans une
perspective socio-anthropologique.
Résultats : Les témoignages convergent
inévitablement vers les dispositifs de contrôle mis en place autour de la
procréation et de l’enfant à naître. La femme enceinte est ainsi invitée à se
conformer à de nouvelles normes sociales et médicales par le biais de programmes
gouvernementaux et d’un suivi de grossesse standardisé. Le pouvoir s’exerce de
manière diffuse en faisant appel à sa responsabilisation face à la prise de
bonnes décisions pour produire un enfant en santé. L’anticipation du risque et
la technologie occupent une place prégnante sur le vécu des parents et il est
difficile pour eux de s’y soustraire.
Conclusions : Les dispositifs de
surveillance et de contrôle sur la vie anténatale ne cessent de croître et le
développement de la technologie, avec la gamme de nouveaux dépistages
génétiques, laisse entrevoir des conséquences importantes sur la signification
de la « normalité » et l’acceptabilité des naissances hors standards.
Contribution : Cet article contribue à
montrer les effets des nouvelles technologies sur l’anticipation de l’enfant et
les débuts de la grossesse ainsi qu’à constater la progression de la temporalité
anténatale induite par la précocité des tests de grossesse.
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Affiliation(s)
- Raymonde Gagnon
- Professeure, Université du Québec à Trois-Rivières (Canada), Centre d’études interdisciplinaires sur le développement de l’enfant et la famille,
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Faya Robles A. Health regulations and social experiences of ‘high-risk’ pregnancies among young working-class women in Brazil. HEALTH, RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1638890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Alfonsina Faya Robles
- Leasp, 1027-INSERM (French National Institute of Health and Medical Research), Toulouse, France
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7
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Maffi I, Gouilhers S. Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan. HEALTH, RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1621996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Irene Maffi
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Solène Gouilhers
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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8
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Ross E. Gestating bodies: sensing foetal movement in first-time pregnancy. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:95-111. [PMID: 30171609 DOI: 10.1111/1467-9566.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A large body of literature engages with personal accounts of pregnancy to illustrate the subjugation of women's embodied experience by practices of biomedicine. This article explores this issue through women's accounts of sensing initial foetal movement, drawn from qualitative interviews with 15 women resident in the UK. Participants depict this aspect of pregnant embodiment as ambiguous and indefinite, in contrast to clinical and popular representations of foetal movement. In highlighting the uncertainties characteristic of this corporeal event, the article adds to literature destabilising understandings of pregnant women's and foetal bodies as bounded and distinct. Ambiguous experiences of foetal movement arise in the context of sociocultural framings of pregnancy as 'at risk', and in turn, may be seen to contribute to these representations, with some participants articulating that uncertain sensations could provoke anxiety. In this article, perceptions of foetal movement are emphasised as valuable to women, and as inextricable from the social settings in which they emerge. This research has implications for sociological and feminist discussions of pregnancy, and work exploring the mutual shaping of corporeality and sociocultural contexts more widely.
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Affiliation(s)
- Emily Ross
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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9
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Ross E. Provisionally pregnant: uncertainty and interpretive work in accounts of home pregnancy testing. Health (London) 2017; 22:87-105. [DOI: 10.1177/1363459317739439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Upon their availability for purchase in the 1970s, home pregnancy testing devices were hailed as a ‘revolution’ for women’s reproductive rights. Some authors, however, have described these technologies as further enabling the medicalisation of pregnancy and as contributing to the devaluing of women’s embodied knowledge. The home pregnancy test is one of many technological devices encountered by women experiencing pregnancy in the United Kingdom today. Existing literature has described how engagement with medical technologies during pregnancy might address uncertainties experienced at this time, providing women with reassurance and alleviating anxieties. Drawing on interviews with women living in Scotland, this article explores accounts of testing for a first pregnancy, and women’s descriptions of the impacts of home pregnancy testing upon experiences of early gestation. Participants engaged with pregnancy tests in varying ways, with uses shaping and shaped by their experiences of early pregnancy more broadly. Particular technical characteristics of the home pregnancy test led many participants to question their interpretation of a positive result, as well as the accuracy of the test itself. Rather than addressing the unknowns of early gestation by confirming a suspected pregnancy, a positive result could thus exacerbate uncertainty. Through participants’ accounts, this article shows how uncertainty is lived out by users of mundane techno-medical artefacts and sheds new light on women’s experiences of the first trimester of pregnancy.
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Thomas GM, Roberts J, Griffiths FE. Ultrasound as a technology of reassurance? How pregnant women and health care professionals articulate ultrasound reassurance and its limitations. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:893-907. [PMID: 28326555 DOI: 10.1111/1467-9566.12554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The premise that ultrasound technologies provide reassurance for pregnant women is well-rehearsed. However, there has been little research about how this reassurance is articulated and understood by both expectant mothers and health care professionals. In this article, we draw on two qualitative UK studies to explore the salience of ultrasound reassurance to women's pregnancy experiences whilst highlighting issues around articulation and silence. Specifically, we capture how expectant parents express a general need for reassurance and how visualisation and the conduct of professionals have a crucial role to play in accomplishing a sense of reassurance. We also explore how professionals have ambiguities about the relationship between ultrasound and reassurance, and how they subsequently articulate reassurance to expectant mothers. By bringing two studies together, we take a broad perspectival view of how gaps and silences within the discourse of ultrasound reassurance leave the claims made for ultrasound as a technology of reassurance unchallenged. Finally, we explore the implications this can have for women's experiences of pregnancy and health care professionals' practices.
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Affiliation(s)
| | - Julie Roberts
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
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Collins LC, Nerlich B. How certain is 'certain'? Exploring how the English-language media reported the use of calibrated language in the Intergovernmental Panel on Climate Change's Fifth Assessment Report. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2016; 25:656-673. [PMID: 25847719 DOI: 10.1177/0963662515579626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article presents findings from an analysis of English-language media reports following the publication of the fifth Intergovernmental Panel on Climate Change Assessment Report in September 2013. Focusing on the way they reported the Intergovernmental Panel on Climate Change's use of 'calibrated' language, we find that of 1906 articles relating to the issuing of the report only 272 articles (14.27%) convey the use of a deliberate and systematic verbal scale. The Intergovernmental Panel on Climate Change's carefully calibrated language was rarely discussed or explicated, but in some instances scientists, political actors or journalists would attempt to contextualise or elaborate on the reported findings by using analogies to other scientific principles or examples of taking action despite uncertainty. We consider those analogies in terms of their efficacy in communicating (un)certainty.
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Gillespie C. The risk experience: the social effects of health screening and the emergence of a proto-illness. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:973-987. [PMID: 25912148 DOI: 10.1111/1467-9566.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Those who undergo health screening often experience physical and emotional effects as a result of the screening process. However, the effects of health screening go beyond these physical and mental complications, often having profound social effects for those who are screened. This study explores the social implications of health screening for people who undergo it and are designated as being at risk for potential disease. Through a qualitative analysis of the experiences of individuals with elevated cholesterol levels and men with elevated prostate-specific antigen (PSA) levels, this research offers a description of the experience of being at risk, identifying three primary components: increased medical contact, a restructuring of everyday routines and altered social relationships. Whereas the at-risk health status engendered by current clinical approaches to screening and surveillance has been characterised as proto-disease, this study develops a companion definition of proto-illness to characterise the social experience of life with an identified health risk. Those who are at risk act in ways that are similar to those who are ill. The concept of proto-illness implies that the experience of risk is parallel to the experience of illness and contributes to the sociology of medical screening by establishing a much needed bridge between the two experiences.
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Affiliation(s)
- Chris Gillespie
- Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford Massachusetts, USA
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Roberts J, Griffiths FE, Verran A, Ayre C. Why do women seek ultrasound scans from commercial providers during pregnancy? SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:594-609. [PMID: 26094706 DOI: 10.1111/1467-9566.12218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The commercial availability of ultrasound scans for pregnant women has been controversial yet little is known about why women make use of such services. This article reports on semi-structured interviews with women in the UK who have booked a commercial scan, focusing on the reasons women gave for booking commercially provided ultrasound during a low-risk pregnancy. Participants' reasons for booking a scan are presented in five categories: finding out the sex of the foetus; reassurance; seeing the baby; acquiring keepsakes and facilitating bonding. Our analysis demonstrates that women's reasons for booking commercial scans are often multiple and are shaped by experiences of antenatal care as well as powerful cultural discourses related to 'good' parenting and the use of technology in pregnancy. Sociological and public debate about the availability of commercial ultrasound and its social and personal impacts should consider the wider sociocultural context that structures women's choices to make use of such services.
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Affiliation(s)
- Julie Roberts
- School of Health Sciences, Nottingham, UK
- Warwick Medical School, Coventry, UK
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Yau AH, Zayts OA. ‘I don’t want to see my children suffer after birth’: the ‘risk of knowing’ talk and decision-making in prenatal screening for Down’s syndrome in Hong Kong. HEALTH RISK & SOCIETY 2014. [DOI: 10.1080/13698575.2014.913008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Heyman B. Health care through the ‘lens of risk’: reflections on the recent series of four special issues. HEALTH, RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.870536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Welsh P, Brown S. ‘I’m not insane, my mother had me tested’: the risk and benefits of being labelled ‘at-risk’ for psychosis. HEALTH, RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.848846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Heyman B, Brown P. Perspectives on ‘the lens of risk’ interview series: interviews with Tom Horlick-Jones, Paul Slovic and Andy Alaszewski. HEALTH RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.830698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hammer RP, Burton-Jeangros C. Tensions around risks in pregnancy: a typology of women's experiences of surveillance medicine. Soc Sci Med 2013; 93:55-63. [PMID: 23906121 DOI: 10.1016/j.socscimed.2013.05.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 11/20/2022]
Abstract
The experience of pregnancy is currently driven by the development of surveillance medicine focused on the monitoring of a wide range of risks. Research usually relies on binary categories opposing women accepting medical surveillance to those resisting it. Recent studies have however underlined the complexity of women's experiences, as well as the ambivalence of their attitudes toward medical procedures and recommendations. Based on 47 qualitative semi-structured interviews conducted in Switzerland between 2008 and 2009, this paper presents the diversity of pregnant women's experiences of surveillance medicine through the description of four contrasting groups: "endorsing surveillance medicine", "coping with risks", "striving for certainty" and "questioning surveillance medicine". Taking into account various risks related to pregnancy, these empirically-grounded groups are discussed in relation to the cultural dynamics of contemporary risk discourses.
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Affiliation(s)
- Raphaël P Hammer
- University of Health Sciences, Institute of Health Research, 21, av. de Beaumont, 1011 Lausanne, Switzerland.
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