Decision-making process of prenatal screening described by pregnant women and their partners

Conditions for autonomous reproductive decision-making in prenatal screening: A mixed methods study

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.

Non-Invasive Prenatal Testing for "Non-Medical" Traits: Ensuring Consistency in Ethical Decision-Making

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.

Expectant Fathers' perceptions towards high-risk pregnancy and experiences in this period: A study of hermeneutic phenomenology

BACKROUND

High-risk pregnancy affects maternal and infant health negatively and it may be the beginning of a process with traumatic outcomes for women and their spouses. Identifying the experiences and perceptions of expectant fathers in this process is important to develop support factors for women and their spouses.

OBJECTIVE

To identify expectant fathers' perceptions towards high-risk pregnancy and their experiences during the high-risk pregnancy period.

PARTICIPANTS

Fifteen expectant fathers whose spouses were admitted to the hospital due to high-risk pregnancy were interviewed for the study.

DESIGN

This study was conducted using an interpretive paradigm based on the Heideggerian hermeneutic phenomenology, which is a qualitative research method. Data were collected through in-depth telephonic interviews. The interviews were recorded, transcribed verbatim and analyzed thematically.

FINDINGS

Four main themes were obtained: "Emotional burden", "Coping mechanisms", "Adaptation to fatherhood" and "High-risk pregnancy journey". The expectant fathers said that they had so many emotions during this process, could cope by praying and with support from their spouses, longed for their unborn child and had increased responsibilities due to paternity.

CONCLUSIONS

The results of this study indicated that men struggled emotionally, had very few coping strategies, questioned the high-risk pregnancy process, had several expectations and formed father-infant attachment during the high-risk pregnancy. Further studies are needed that review how midwives and nurses can support expectant fathers in this process and that provide opportunities for the improvement of clinical roles in this regard.

Evaluation of a prenatal screening decision aid: A mixed methods pilot study

BACKGROUND

We developed a decision aid (DA) to help pregnant women and their partners make informed decisions about prenatal screening for trisomy. We aimed to determine its usefulness for preparing for decision-making and its acceptability among end-users.

METHODS

In this mixed-methods pilot study, we recruited participants in three prenatal care settings in Quebec City. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. We asked them about the usefulness of the DA using an interview grid based on the Technology Acceptance Model. We performed descriptive statistics and deductive analysis.

RESULTS

Thirty-nine dyads or individuals participated in the study. Mean usefulness score was 86.2 ± 13. Most participants found the amount of information in the DA just right (79.5%), balanced (89.7%), and very useful (61.5%). They were less satisfied with the presentation and the values worksheet and suggested different values clarification methods.

CONCLUSION

Rigorous pilot tests of DAs with patients are an important stage in their development before the more formal assessments that precede scaling up the DA in clinical practice.

PRACTICE IMPLICATIONS

The next version of the DA will integrate the suggestions of end-users for better decision-making processes about prenatal screening for trisomy.

Counselling and education for prenatal screening and diagnostic tests for pregnant women: Randomized controlled trial

AIM

The aim of this study is to evaluate the effect of education and counselling on prenatal screening and diagnostic tests on pregnant women's decisional conflict, anxiety levels and attitudes towards the tests.

BACKGROUND

Clinical practice guidelines recommend prenatal genetic counselling for pregnant women before participation in the tests.

METHODS

A total of 210 pregnant women participated in the study by completing the State-Trait Anxiety Inventory-I, Decisional Conflict Scale, SURE Scale, Knowledge Assessment Forms, Decision Satisfaction Form and Attitudes Scale between June 2017 and March 2018. In the first stage, pregnant women were evaluated who had only prenatal genetic screening tests and in the second stage, pregnant women who had been recommended to receive diagnostic tests. The intervention group received face-to-face individual education and counselling about prenatal genetic tests. Independent samples t test, t tests and Pearson correlation tests were used.

RESULTS

Education and counselling for prenatal screening tests and diagnostic tests from the first weeks of pregnancy were effective in decreasing anxiety, decisional conflict, increasing attitudes towards tests and had positive effects on pregnant women's knowledge level and decision satisfaction (P < 0.005).

CONCLUSION

Prenatal genetic counselling and education are more effective if provided from the first weeks of pregnancy. Decreasing anxiety, decisional conflict and increasing knowledge levels of pregnant women are important to make informed decisions.

Balancing Needs and Autonomy: The Involvement of Pregnant Women's Partners in Decisions About cfDNA

Cell-free fetal DNA (cfDNA) screening is used to identify the presence of fetal genetic variants early in pregnancy. Patients' informed decision-making is central to the success of this new screen in clinical practice. Although research has focused on pregnant women's decision-making, little is known about partners' role and preferences as a member of the decision-making dyad. Using a grounded theory approach, this study analyzed 23 in-depth interviews to examine partners' perspectives about cfDNA screening and preferences with respect to their role in the decision-making process. Participants wished to be actively involved in testing decisions. They articulated a distinct set of needs and preferences in the decision-making process. Such involvement was hindered by several biological and logistical barriers. This study demonstrates the need to develop mechanisms that foster informed decision-making for cfDNA screening and related new reproductive genetic technologies that focus on not just the pregnant woman but also the decision-making dyad that includes her partner as well.

Couple's Narratives of Communion and Isolation Following Abnormal Prenatal Microarray Testing Results

In 2% to 3% of cases, prenatal microarray testing detects deletions and duplications in a fetus' genome that are undetected by conventional cytogenetics. Many of these changes are associated with variable or uncertain symptomatology. Little is known about how couples experience uncertain results. This study analyzed 24 interviews with members of 12 heterosexual U.S. couples who received pathogenic or uncertain microarray prenatal testing results. Researchers used narrative analysis to examine couples' understanding and incorporation of findings into decision making regarding pregnancy termination. Couples felt unprepared for these findings and frustrated because scant information was available to aid interpretation. Women sought information and made decisions, and men marginalized their distress to support their wives. A shift in voice from first to second person indicated attempts to normalize emotional responses by making the process "common" to all couples. Families pursuing highly sensitive prenatal testing may need expert guidance to support decision making.

Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals

Sweden has a reputation for gender equality, and its child health services seek to support both parents. However, this meta-ethnographic analysis of 62 studies from 2000 to 2015 covering prenatal clinics, labour and birth wards, postnatal wards and child health centres found programmes had not been designed around paternal needs. Therefore, despite the policy change nearly 50 years ago to include both parents, fathers were still not fully accepted and supported.

CONCLUSION

To provide fathers in Sweden with greater support throughout the child health field, organisational changes should be considered, as this could provide further beneficial outcomes for children, families and society.

It's complicated - Factors predicting decisional conflict in prenatal diagnostic testing

BACKGROUND

The technologies currently available to detect the presence of foetal genetic abnormalities are complex, and undergoing prenatal diagnostic testing can have wide-ranging repercussions. Before individuals can decide with certainty whether or not to take these tests, they first need to grasp the many psychosocial and clinical dimensions of prenatal genetic testing.

OBJECTIVE

To test a model integrating key psychosocial and clinical factors as predictors of decisional conflict in decisions about whether or not to undergo prenatal genetic testing.

METHOD

Adults (n = 457) read one of four hypothetical scenarios asking them to imagine expecting a child and considering the option of a prenatal test able to detect a genetic condition; age of condition onset (birth vs. adulthood) and its curability (no cure vs. curable) were manipulated. Participants completed measures of decisional conflict, perceived benefits from normal results, test response efficacy, condition coherence, child-related worry, perceived disagreement with the other parent's preference, motivation to comply with doctors' perceived preferences, and parity.

RESULTS

Prenatal testing decisional conflict was positively predicted by perceiving normal results as beneficial, doubting the test's reliability, lacking understanding of the genetic condition, worrying about the health of the foetus, perceiving differences of opinion from partner/spouse, wanting to follow doctors' preferences, and being childless.

DISCUSSION

These results, of growing relevance given the increasing availability of new technologies in pregnancy care, can inform communication strategies that facilitate couples' decision making.

CONCLUSION

This study provides insights into factors that might complicate prenatal testing decision making.