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Aboleil-Zoubi O, Gafni-Amsalem C, Peled-Perets L, Mamluk E, Tamir L, Hakrosh S, Kurtzman S, Chervinsky E, Aalimi U, Husam B, Khayat M, Baram-Tsabari A, Shalev SA. The effect of a prior e-learning tool on genetic counseling outcomes in diverse ethnic couples with abnormal Down syndrome screening tests: A randomized controlled trial. J Genet Couns 2024; 33:666-676. [PMID: 37632224 DOI: 10.1002/jgc4.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Genetic counseling (GC) following abnormal Down syndrome (DS) screening tests aims to ensure learning of complex medical concepts and discussion of counselees' personal desires. Pre-GC use of electronic learning tools (e-learning tools) can facilitate GC sessions by allowing more time for dialogue rather than learning medical and genetic concepts, enabling greater focus on the counselee's decisional, psychological, and personal needs. Few studies have investigated such tools for DS screening tests and those who have focused on screening uptake rather than abnormal results and implications. This study evaluated prenatal GC outcomes following implementation of an e-learning tool utilizing an educational animated movie for couples of varied ethnic backgrounds in northern Israel, with abnormal DS screening tests. E-learning tool impact was assessed as knowledge level, informed choices, satisfaction with the intervention and GC process, the state of anxiety and duration of the GC meeting. The 321 study participants were randomized to three groups: animation movie, booklet, and control. All participants had been asked to complete pre- and post-counseling questionnaires. Outcome scores were compared between the research groups. Results showed increased knowledge level in general among participants in the animation group; among minority participants, the highest knowledge level was in the animation group. Anxiety levels and informed choices were not statistically different among the groups. However, watching the animation, Jewish ethnicity, good level of genetic literacy, and academic degree were significant predictors of informed choice, and those who watched the animation were three times more likely to make an informed choice than the control group. Our findings suggest that this e-learning tool is efficient and acceptable for the general population. Special attention is needed for minorities with lower genetic literacy and education.
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Affiliation(s)
- Olfat Aboleil-Zoubi
- The Genetics Institute Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Gafni-Amsalem
- The Genetics Institute Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Efrat Mamluk
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Liron Tamir
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Shadia Hakrosh
- The Genetics Institute Emek Medical Center, Afula, Israel
| | | | | | - Ula Aalimi
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Bashir Husam
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Morad Khayat
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Ayelet Baram-Tsabari
- Faculty of Education in Science and Technology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Stavit A Shalev
- The Genetics Institute Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Damman OC, Henneman L, IJssel DVVD, Timmermans DRM. Conditions for autonomous reproductive decision-making in prenatal screening: A mixed methods study. Midwifery 2023; 119:103607. [PMID: 36753831 DOI: 10.1016/j.midw.2023.103607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pregnant women should be able to make autonomous and meaningful decisions about prenatal screening for fetal abnormalities. It remains largely unclear which circumstances facilitate or hinder such a decision-making process. OBJECTIVE To investigate what conditions Dutch pregnant women and professional experts consider important for autonomous reproductive decision-making in prenatal screening for fetal abnormalities, and the extent to which, according to women, those conditions are met in practice. METHODS A mixed methods study was conducted in the Netherlands in 2016-2017. A conceptual model was used to interview professional experts (n = 16) and pregnant women (n = 19). Thematic analysis was performed to identify important conditions. Subsequently, a questionnaire assessed the perceived importance of those conditions and the extent to which these were met, in the experience of pregnant women (n = 200). RESULTS Professional experts stressed the importance of information provision, and emphasized a rational decision-making model. Pregnant women differed in what information they felt was needed, and this depended on the screening decision made. Questionnaire findings showed that women prioritized discussion and consensus with partners. Information about test accuracy and miscarriage risk of invasive follow-up testing was also considered important. Two key conditions were not adequately met, in the experience of women: (1) having information about miscarriage risk; (2) not being directed by health professionals in decision-making. CONCLUSION According to women, discussion and consensus with partners was considered a highly important condition for an autonomous and meaningful decision-making process. Access to information about safety of testing and ensuring that women are not being directed in their decision-making by health professionals seem to be areas for improvement in prenatal care practice.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Section Community Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Dalisa V van den IJssel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Xian Lim KM, Lewis C, Wong HC, Chong GSL, Gosavi A, Choolani MA. Does an educational video for aneuploidy screening improve informed choice among pregnant women? A randomised controlled trial. Prenat Diagn 2023; 43:42-50. [PMID: 36550063 PMCID: PMC10107633 DOI: 10.1002/pd.6279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Poor knowledge and the lack of deliberation have been cited as reasons for women making uninformed choices about aneuploidy screening. Adequate pre-test counselling is of particular importance where non-invasive prenatal screening (NIPS) is being increasingly offered as a primary screening test. DESIGN Women attending the antenatal clinic with a singleton pregnancy below 14 weeks were randomised to receive routine counselling or the intervention-a 16-min educational video on aneuploidy screening before their consult. The primary outcome, rate of informed choice, was assessed using an adapted multidimensional measure of informed choice questionnaire, where informed choice was defined as good knowledge and value-consistent behaviour. Secondary outcomes included informed choice with deliberation, decisional conflict and anxiety. RESULTS Two hundred and eighty-six women were recruited. 69.8% of women in the intervention group made an informed choice compared with 53.6% in the control group (Risk Ratio [RR] 1.30, p = 0.014). A significantly higher number of women in the intervention group had good knowledge compared to controls (81% vs. 60.9%; RR 1.33, p = 0.001). Decisional conflict did not differ between groups, but women in the intervention group had higher anxiety scores (p < 0.001). CONCLUSION The study intervention was effective in helping women make informed choice. Qualitative studies to determine the reason for increased anxiety are needed. TRIAL REGISTRATION Trial registry: ClinicalTrials.gov; Identifier: NCT05492981.
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Affiliation(s)
- Karen Mei Xian Lim
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - Celine Lewis
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.,London North Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Hung Chew Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Glenda Sze Ling Chong
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - Arundhati Gosavi
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Arjandas Choolani
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Carlsson Y, Strömbäck P, Lundgren I. Parents' experiences of the information provided at the antenatal clinic regarding foetal diagnostics - A qualitative interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100652. [PMID: 34375881 DOI: 10.1016/j.srhc.2021.100652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/02/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to examine the pregnant women's and their partner's experience of the information given at the antenatal clinic regarding screening methods. METHODS A qualitative interview study was conducted in the Gothenburg area in Sweden. Ten women and seven partners expecting their first child were interviewed adjacent to the second-trimester ultrasound examination. The data were analysed using qualitative content analysis. RESULTS The findings present an overall theme, three main categories, and ten subcategories. The overall theme showed a nonhomogeneous and individually based picture concerning the meaning and purpose of the methods, need for improvement of information, parents own information seeking, and the encounter with the midwife was also experienced as an influential encounter. The main categories show that diversity relates to the level of information given, voluntariness, the possibility of abnormal findings, and varying needs to thorough information and pre-existing knowledge. The midwifés impact was related to attitude, openness for questions, time for explanations, and the balance between providing enough information to support without worrying the parents. CONCLUSIONS Although previous research has pointed out a decade ago that information regarding foetal diagnostics is lacking, this study shows that these shortcomings still exist and that improvement is needed. The given information should be explicit concerning the purpose, limitations, and voluntariness of prenatal testing. Sufficient time for questions and discussion is as important as considering the parents' pre-existing knowledge, individual thoughts or questions, and a neutral attitude from the midwife is desirable.
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Affiliation(s)
- Ylva Carlsson
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, 405 83 Gothenburg, Sweden; Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden.
| | - Pernilla Strömbäck
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, 405 83 Gothenburg, Sweden
| | - Ingela Lundgren
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, 405 83 Gothenburg, Sweden; Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden.
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Bunnik EM, Kater-Kuipers A, Galjaard RJH, de Beaufort ID. Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access. JOURNAL OF MEDICAL ETHICS 2020; 46:194-198. [PMID: 31527142 PMCID: PMC7042959 DOI: 10.1136/medethics-2019-105675] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 05/28/2023]
Abstract
The introduction of non-invasive prenatal testing (NIPT) in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to (co)pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: (1) to prevent increased uptake of NIPT and (2) to promote informed choice. First, given the aim of prenatal screening (reproductive autonomy), high or low uptake rates are not intrinsically desirable or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women's choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external (ie, financial) influences on women's personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring (substantial) copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair.
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Affiliation(s)
- Eline M Bunnik
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Adriana Kater-Kuipers
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inez D de Beaufort
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Fumagalli S, Antolini L, Nespoli A, Vergani P, Ferrazzi E, Oggioni S, Locatelli A. Prenatal diagnosis tests and women's risk perception: a cross-sectional study. J Psychosom Obstet Gynaecol 2018. [PMID: 28635537 DOI: 10.1080/0167482x.2017.1291622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate women's decision to undergo non-invasive and/or invasive tests for prenatal diagnosis depending on the procedure-related risk and the risk of carrying a foetus with Down syndrome (DS). Both risks are rated in terms of numerical relevance and acceptability. METHOD A sample of 448 consecutive women with low-risk pregnancies were interviewed to collect social and clinical variables and to determine their perceptions of the risks of invasive procedure-related miscarriage and carrying a foetus with DS. The risks were scored numerically in terms of their relevance and acceptability using a 10-point rating scale. RESULTS The factors related to the use of non-invasive tests were age ≥35 years, not being treated at a public service, rating the risk of carrying a foetus with DS as having high numerical relevance and low acceptability, and rating the risk of miscarriage as having high acceptability. These relationships were still present when the use of invasive tests was considered, except in terms of the numerical relevance of the risk of carrying a foetus with DS. CONCLUSION Perceived acceptability affects the interpretation of a given risk more than the numerical relevance of the risk.
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Affiliation(s)
- Simona Fumagalli
- a School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy
| | - Laura Antolini
- a School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy
| | - Antonella Nespoli
- a School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy
| | - Patrizia Vergani
- a School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy
| | | | - Sara Oggioni
- a School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy
| | - Anna Locatelli
- a School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy
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Delanoë A, Lépine J, Turcotte S, Leiva Portocarrero ME, Robitaille H, Giguère AM, Wilson BJ, Witteman HO, Lévesque I, Guillaumie L, Légaré F. Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey. J Med Internet Res 2016; 18:e283. [PMID: 27793792 PMCID: PMC5106559 DOI: 10.2196/jmir.6362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs. OBJECTIVE The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention. METHODS We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses. RESULTS Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92). CONCLUSIONS Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.
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Affiliation(s)
- Agathe Delanoë
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Johanie Lépine
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Stéphane Turcotte
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Hubert Robitaille
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anik Mc Giguère
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Quebec Centre of Excellence on Aging, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Holly O Witteman
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Isabelle Lévesque
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - France Légaré
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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8
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Lépine J, Leiva Portocarrero ME, Delanoë A, Robitaille H, Lévesque I, Rousseau F, Wilson BJ, Giguère AMC, Légaré F. What factors influence health professionals to use decision aids for Down syndrome prenatal screening? BMC Pregnancy Childbirth 2016; 16:262. [PMID: 27596573 PMCID: PMC5011951 DOI: 10.1186/s12884-016-1053-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023] Open
Abstract
Background Health professionals are expected to engage pregnant women in shared decision making to help them make informed values-based decisions about prenatal screening. Patient decision aids (PtDAs) foster shared decision-making, but are rarely used in this context. Our objective was to identify factors that could influence health professionals to use a PtDA for decisions about prenatal screening for Down syndrome during a clinical pregnancy follow-up. Methods We planned to recruit a purposive sample of 45 health professionals (obstetrician-gynecologists, family physicians and midwives) involved in the care of pregnant women in three clinical sites (15 per site). Participating health professionals first watched a video showing two simulated consecutive prenatal follow-up consultations during which a pregnant woman, her partner and a health professional used a PtDA about Down syndrome prenatal screening. Participants were then interviewed about factors that would influence their use of the PtDA. Questions were based on the Theoretical Domains Framework. We performed content analyses of transcribed verbatim interviews. Results Out of 42 eligible health professionals approached, 36 agreed to be interviewed (86 % response rate). Of these, 27 were female (75 %), nine were obstetrician-gynecologists (25 %), 15 were family physicians (42 %), and 12 were midwives (33 %), with a mean age of 42.1 ± 11.6 years old. We identified 35 distinct factors reported by 20 % or more participants that were mapped onto 10 of the 12 of the Theoretical Domains Framework domains. The six most frequently mentioned factors influencing use of the PtDA were: 1) a positive appraisal (n = 29, 81 %, beliefs about consequences domain); 2) its availability in the office (n = 27, 75 %, environmental context and resources domain); 3) colleagues’ approval (n = 27, 75 %, social influences domain); 4) time constraints (n = 26, 72 %, environmental context and resources domain); 5) finding it a relevant source of information (n = 24, 67 %, motivation and goals domain); and 6) not knowing any PtDAs (n = 23, 64 %, knowledge domain). Conclusions Appraisal, PtDA availability, peer approval, time concerns, evidence and PtDA awareness all affect whether health professionals are likely to use a PtDA to help pregnant women make informed decision about Down syndrome screening. Implementation strategies will need to address these factors. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1053-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johanie Lépine
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Maria Esther Leiva Portocarrero
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Agathe Delanoë
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Hubert Robitaille
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Isabelle Lévesque
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, and MSSS/FRQS/CHUQ Research Chair in Health Technology Assessment and Evidence Based Laboratory Medicine, Quebec, Canada
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Anik M C Giguère
- Quebec Centre of Excellence on Aging, CHU de Québec Research Centre, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada. .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada. .,CHU de Québec Research Centre (CRCHUQ), Hôpital Saint-François d'Assise, Université Laval, 10 rue de l'Espinay, Local D6-737, Quebec, QC, G1L 3L5, Canada.
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9
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Bouzid A, Ayachi A, Dhaoudi H, Mourali M. Pertinence des marqueurs sériques du premier trimestre pour prédire les complications de la grossesse : étude prospective tunisienne. ACTA ACUST UNITED AC 2016; 44:96-100. [DOI: 10.1016/j.gyobfe.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
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Leiva Portocarrero ME, Garvelink MM, Becerra Perez MM, Giguère A, Robitaille H, Wilson BJ, Rousseau F, Légaré F. Decision aids that support decisions about prenatal testing for Down syndrome: an environmental scan. BMC Med Inform Decis Mak 2015; 15:76. [PMID: 26404088 PMCID: PMC4583147 DOI: 10.1186/s12911-015-0199-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prenatal screening tests for Down syndrome (DS) are routine in many developed countries and new tests are rapidly becoming available. Decisions about prenatal screening are increasingly complex with each successive test, and pregnant women need information about risks and benefits as well as clarity about their values. Decision aids (DAs) can help healthcare providers support women in this decision. Using an environmental scan, we aimed to identify publicly available DAs focusing on prenatal screening/diagnosis for Down syndrome that provide effective support for decision making. METHODS Data sources searched were the Decision Aids Library Inventory (DALI) of the Ottawa Patient Decision Aids Research Group at the Ottawa Health Research Institute; Google searches on the internet; professional organizations, academic institutions and other experts in the field; and references in existing systematic reviews on DAs. Eligible DAs targeted pregnant women, focused on prenatal screening and/or diagnosis, applied to tests for fetal abnormalities or aneuploidies, and were in French, English, Spanish or Portuguese. Pairs of reviewers independently identified eligible DAs and extracted characteristics including the presence of practical decision support tools and features to aid comprehension. They then performed quality assessment using the 16 minimum standards established by the International Patient Decision Aids Standards (IPDASi v4.0). RESULTS Of 543 potentially eligible DAs (512 in DALI, 27 from experts, and four on the internet), 23 were eligible and 20 were available for data extraction. DAs were developed from 1996 to 2013 in six countries (UK, USA, Canada, Australia, Sweden, and France). Five DAs were for prenatal screening, three for prenatal diagnosis and 12 for both). Eight contained values clarification methods (personal worksheets). The 20 DAs scored a median of 10/16 (range 6-15) on the 16 IPDAS minimum standards. DISCUSSION None of the 20 included DAs met all 16 IPDAS minimum standards, and few included practical decision support tools or aids to comprehension. CONCLUSIONS Our results indicate there is a need for DAs that effectively support decision making regarding prenatal testing for Down syndrome, especially in light of the recently available non-invasive prenatal screening tests.
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Affiliation(s)
- Maria Esther Leiva Portocarrero
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Mirjam M Garvelink
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Maria Margarita Becerra Perez
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Anik Giguère
- />Centre d’excellence sur le vieillissement de Québec, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
- />Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, 1050, avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Hubert Robitaille
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Brenda J. Wilson
- />Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - François Rousseau
- />Department of Molecular biology, Medical Biochemistry and Pathology, Faculty of Medicine, Pavillon Ferdinand-Vandry, Université Laval, 1050, avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- />MSSS/FRQS/CHUQ Research Chair in Health Technology Assessment and Evidence-based Laboratory Medicine, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - France Légaré
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
- />Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, 1050, avenue de la Médecine, Quebec, QC G1V 0A6 Canada
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Skjøth MM, Hansen HP, Draborg E, Pedersen CD, Lamont RF, Jørgensen JS. Informed Choice for Participation in Down Syndrome Screening: Development and Content of a Web-Based Decision Aid. JMIR Res Protoc 2015; 4:e113. [PMID: 26392319 PMCID: PMC4704943 DOI: 10.2196/resprot.4291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/06/2015] [Accepted: 07/03/2015] [Indexed: 12/26/2022] Open
Abstract
Background In Denmark, all pregnant women are offered screening in early pregnancy to estimate the risk of having a fetus with Down syndrome. Pregnant women participating in the screening program should be provided with information and support to allow them to make an informed choice. There is increasing interest in the use of Web-based technology to provide information and digital solutions for the delivery of health care. Objective The aim of this study was to develop an eHealth tool that contained accurate and relevant information to allow pregnant women to make an informed choice about whether to accept or reject participation in screening for Down syndrome. Methods The development of the eHealth tool involved the cooperation of researchers, technology experts, clinicians, and users. The underlying theoretical framework was based on participatory design, the International Patient Decision Aid Standards (IPDAS) Collaboration guide to develop a patient decision aid, and the roadmap for developing eHealth technologies from the Center for eHealth Research and Disease Management (CeHRes). The methods employed were a systematic literature search, focus group interviews with 3 care providers and 14 pregnant women, and 2 weeks of field observations. A qualitative descriptive approach was used in this study. Results Relevant themes from pregnant women and care providers with respect to information about Down syndrome screening were identified. Based on formalized processes for developing patient decision aids and eHealth technologies, an interactive website containing information about Down syndrome, methods of screening, and consequences of the test was developed. The intervention was based on user requests and needs, and reflected the current hospital practice and national guidelines. Conclusions This paper describes the development and content of an interactive website to support pregnant women in making informed choices about Down syndrome screening. To develop the website, we used a well-structured process based on scientific evidence and involved pregnant women, care providers, and technology experts as stakeholders. To our knowledge, there has been no research on the combination of IPDAS standards and the CeHRes roadmap to develop an eHealth tool to target information about screening for Down syndrome.
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Affiliation(s)
- Mette Maria Skjøth
- Research Unit of Gynecology and Obstetrics, Department of Gynecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
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Skjøth MM, Draborg E, Lamont RF, Pedersen CD, Hansen HP, Ekstrøm CT, Jørgensen JS. Informed choice about Down syndrome screening - effect of an eHealth tool: a randomized controlled trial. Acta Obstet Gynecol Scand 2015; 94:1327-36. [PMID: 26332592 DOI: 10.1111/aogs.12758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/16/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effect of an eHealth intervention (interactive website) on pregnant women's ability to make an informed choice about Down syndrome screening. MATERIAL AND METHODS The study was designed as a randomized controlled trial with allocation to an intervention group and a control group in a ratio of 1:1. Subsequent subgroup analysis was conducted. Participants were recruited from 5 August 2013 to 25 April 2014 at Odense University Hospital, Denmark. Inclusion criteria were: pregnant women aged ≥18 years who were invited to participate in Down syndrome screening. Exclusion criteria were: high risk of abortion, psycho-socially vulnerable women, late referral, inability to speak Danish and women declining to participate. The primary outcome was informed choice about Down syndrome screening. The Multidimensional Measure of Informed Choice was used to assess whether the choice was informed or uninformed. RESULTS A total of 1150 participants were included in the study, of which 910 (79%) completed the questionnaire. Only a minority (30% of the women in the intervention group) actually used the website. There was no significant difference in the groups with respect to making an informed choice. The mean knowledge scores were significantly higher for those in the intervention group who used the intervention. CONCLUSIONS An interactive website with information about Down syndrome screening had no direct effect on making an informed choice. However, the majority of the pregnant women who used the website were satisfied with the website and would recommend it to others.
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Affiliation(s)
- Mette M Skjøth
- Department of Gynecology and Obstetrics, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Eva Draborg
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ronald F Lamont
- Department of Gynecology and Obstetrics, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Odense, Denmark.,Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
| | - Claus D Pedersen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Helle P Hansen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Claus T Ekstrøm
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jan S Jørgensen
- Department of Gynecology and Obstetrics, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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