1
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Katada C, Ohashi K, Okada K, Sawai H. Factors related to indecisive attitudes toward non-invasive prenatal testing among women of reproductive age in Japan. J Obstet Gynaecol Res 2023; 49:794-802. [PMID: 36478626 DOI: 10.1111/jog.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
AIM This study aimed to investigate the factors related to indecisive attitudes toward noninvasive prenatal testing (NIPT) among nonpregnant women of reproductive age. METHODS We conducted an online survey involving nonpregnant Japanese women aged 20-49 years. The questionnaires consisted of a hypothetical question about whether they would decide to undergo NIPT if they were to become pregnant, and responses with "unsure" were defined as indecisive attitudes. RESULTS Of 1250 participants, 412 (33%) held indecisive attitudes on whether to undergo NIPT. Multivariable logistic regression analysis demonstrated indecisive attitudes were related to a low level of knowledge about prenatal testing (adjusted odds ratio [AOR] 3.89) and preferences for family-driven decisions (AOR 1.44) instead of provider-driven. CONCLUSION Even though the NIPT is widespread, many nonpregnant women of reproductive age are unable to decide whether to undergo the NIPT or not. Hence, indecisive women toward NIPT require adequate information and communication about future NIPT among their families prior to conception. Therefore, preconception support of providing adequate information about testing and facilitating communication regarding future NIPT among women and their family members may help indecisive women make autonomous decisions on NIPT.
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Affiliation(s)
- Chihiro Katada
- Department of Nursing, Hyogo Medical University, Hyogo, Japan
| | | | - Kimie Okada
- Department of Nursing, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Hideaki Sawai
- Department of Obstetrics and Gynecology, Hyogo Medical University, Hyogo, Japan
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2
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Di Mattei V, Ferrari F, Perego G, Tobia V, Mauro F, Candiani M. Decision-making factors in prenatal testing: A systematic review. Health Psychol Open 2021; 8:2055102920987455. [PMID: 33489303 PMCID: PMC7809316 DOI: 10.1177/2055102920987455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This review examines the factors that affect the decision-making process of parental couples evaluating prenatal screening and diagnostic tests. A systematic search was performed using PubMed and PsycInfo databases. The 46 included studies had to: investigate the decision-making process about prenatal testing; focus on tests detecting trisomy 21, 18, 13, and abnormalities of sex chromosomes; be published in English peer-reviewed journals. The decision-making process seems composed of different levels: an individual level with demographic, clinical, and psychological aspects; a contextual level related to the technical features of the test and the information received; a relational level involving family and society.
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Affiliation(s)
- Valentina Di Mattei
- Vita-Salute San Raffaele University, Italy.,IRCCS San Raffaele Scientific Institute, Italy
| | | | | | | | - Fabio Mauro
- IRCCS San Raffaele Scientific Institute, Italy
| | - Massimo Candiani
- Vita-Salute San Raffaele University, Italy.,IRCCS San Raffaele Scientific Institute, Italy
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3
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Dong D, Ahmed S, Nichini E, Yi H, Jafri H, Rashid Y, Ahmed M, Zhu J. Decision making on antenatal screening results: A comparative Q-method study of women from two Chinese cities. Health Expect 2020; 24:363-376. [PMID: 33316122 PMCID: PMC8077134 DOI: 10.1111/hex.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background Although an integral part of ethical and quality health care, little is known about the informed decision making of Chinese women with different socioeconomic backgrounds within the context of antenatal testing. Methods To explore women's viewpoints on informed decision making regarding antenatal screening, a Q‐methodology study that combines both quantitative factor analysis and interviews was conducted between June 2016 and February 2017 in Shanghai and Duyun. A total of 169 women (84 Shanghai and 85 Duyun) participated in the study of 41 ranked statements along a Q‐sorting grid. Results Using by‐person factor analysis, five distinct viewpoints are identified: (a) choice is shared with the partner/husband, but the mother has the right to make the final decision; (b) having antenatal tests is not about choice but about a mother's responsibility; (c) choice is a shared decision led primarily by the partner/husband and secondarily by the doctors; (d) choice should be made using the advice of doctors, but the decision should be made with the partner/husband; and (e) choice is a responsibility shared with the partner, family and doctors. Conclusions The study reveals that women with better education and higher incomes demonstrate more autonomy than those with less education. The nuclear family clearly emerges as the main decision makers in health‐care services in China. Patient and Public Contribution The 169 participants shared their views and stories for at least an hour. They were debriefed after the interviews and contributed their thoughts on our study design and interpretation of the data.
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Affiliation(s)
- Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elena Nichini
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | | | - Mushtaq Ahmed
- Yorkshire Regional Genetics Service, Leeds NHS Teaching Hospitals Trust, Leeds, UK
| | - Jianfeng Zhu
- Anthropological and Ethnological Research Institute, Fudan-Harvard Medical Anthropology Collaborative Research Center, School of Social Development and Public Policy, Fudan University, Shanghai, China
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4
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Petersen C. User-focused data sharing agreements: a foundation for the genomic future. JAMIA Open 2020; 2:402-406. [PMID: 32025634 PMCID: PMC6993993 DOI: 10.1093/jamiaopen/ooz043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/21/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022] Open
Abstract
Data sharing agreements that clearly describe what individuals are agreeing to and what responsibilities data stewards will undertake are crucial for the establishment, maintenance, and flourishing of genomic datasets. To optimize genomic data resources, researchers, care professionals, and informaticians must regard system design, user objectives, and environmental considerations through users' eyes, identifying fundamental values on which to build and potential barriers to success that must be avoided. Design of agreements that promote desired data sharing and protect valuable data resources as necessary begins with a review of user interests and concerns. Nontraditional approaches for informed consent (eg, abbreviated informed consent, electronic informed consent, and dynamic consent) can facilitate achievement of data donors' privacy-related goals while making data available to researchers. Transparency in individual-researcher interactions, recognition and accommodation of cultural differences, and identification of shared needs and goals create a foundation for data sharing agreements that work over short and long terms.
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Affiliation(s)
- Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Global Business Solutions, Mayo Clinic, Rochester, Minnesota, USA
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5
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Seidler Y, Mosor E, Stamm T. "No one to consult! That is the hardest part" choice-making experiences for prenatal screening tests among Japanese women and their spouses in Austria - A qualitative interview study. PATIENT EDUCATION AND COUNSELING 2019; 102:2286-2295. [PMID: 31358327 DOI: 10.1016/j.pec.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/26/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Japan is the only country in the world that allows abortions due to economic reasons but illegalise them due to foetal anomaly. The objective of this study was to explore the choice-making experiences for prenatal screening among Japanese women and their spouses in Austria. METHODS We conducted a qualitative study using semi-structured face-to-face interviews with Japanese women and their spouses in Austria. Data were analysed using thematic analysis. RESULTS Twenty-five participants (14 women and 11 men) took part in the interviews. Four themes were identified: 1) Knowledge, information and memory; 2) Communication and interactions with health professionals; 3) Reasons for choice; and 4) Emotional support. Participants had limited knowledge and experienced directive counselling. Women expressed negative emotions in the choice-making processes, did not perceive husbands as a source of support and lacked a person to consult. CONCLUSION There are common characteristics among East Asian population despite different context and differences found between our Japanese participants and women in other European countries. PRACTICE IMPLICATION Proactive interventions aimed at increasing knowledge that help women to develop their preferences and reflect on their values could be further promoted among women of all socio-cultural backgrounds in Austria.
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Affiliation(s)
- Yuki Seidler
- Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/ 1, 1090 Vienna, Austria; Center for Health and Migration, Wasagasse 12/3/5, 1090 Vienna, Austria.
| | - Erika Mosor
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
| | - Tanja Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
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6
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Mozersky J, Ravitsky V, Rapp R, Michie M, Chandrasekharan S, Allyse M. Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context. Hastings Cent Rep 2018; 47:41-49. [PMID: 28301696 DOI: 10.1002/hast.690] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential "paradigm shift" in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop.
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7
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O'Brien D, Casey M, Butler MM. Women's experiences of exercising informed choices as expressed through their sense of self and relationships with others in Ireland: A participatory action research study. Midwifery 2018; 65:58-66. [PMID: 30118977 DOI: 10.1016/j.midw.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/27/2018] [Accepted: 07/22/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore women's experiences of the concept of informed choice during pregnancy and childbirth. METHODS A three-phase action research approach. In the second phase of the study (reported in this paper), 15 women were interviewed to establish their experiences of informed choice. SETTING Dublin, Ireland in a large maternity hospital. FINDINGS We found that multiple factors influence how women experience informed choice including; their sense of self and the quality of their relationships with maternity care professionals. Women's experiences as expressed through their sense of self reveal that informed choice, is not only defined by but contingent on the quality of women's relationships with their caregiver and their ability to engage in a process of shared decision-making with them. KEY CONCLUSIONS Informed choice is experienced as a relational construct women's relationships with maternity care professionals can influence their perceptions of their sense of self following childbirth. Supportive relationships are key to supporting the concept of informed choice.
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Affiliation(s)
- Denise O'Brien
- School of Nursing and Midwifery and Health Systems, University College Dublin, Ireland.
| | - Mary Casey
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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8
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Zhong A, Darren B, Loiseau B, He LQB, Chang T, Hill J, Dimaras H. Ethical, social, and cultural issues related to clinical genetic testing and counseling in low- and middle-income countries: a systematic review. Genet Med 2018; 23:2270-2280. [PMID: 30072741 DOI: 10.1038/s41436-018-0090-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/04/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We performed a systematic review of the ethical, social, and cultural issues associated with delivery of genetic services in low- and middle-income countries (LMICs). METHODS We searched 11 databases for studies addressing ethical, social, and/or cultural issues associated with clinical genetic testing and/or counselling performed in LMICs. Narrative synthesis was employed to analyze findings, and resultant themes were mapped onto the social ecological model (PROSPERO #CRD42016042894). RESULTS After reviewing 13,308 articles, 192 met inclusion criteria. Nine themes emerged: (1) genetic counseling has a tendency of being directive, (2) genetic services have psychosocial consequences that require improved support, (3) medical genetics training is inadequate, (4) genetic services are difficult to access, (5) social determinants affect uptake and understanding of genetic services, (6) social stigma is often associated with genetic disease, (7) family values are at risk of disruption by genetic services, (8) religious principles pose barriers to acceptability and utilization of genetic services, and (9) cultural beliefs and practices influence uptake of information and understanding of genetic disease. CONCLUSION We identified a number of complex and interrelated ethical, cultural, and social issues with implications implications for further development of genetic services in LMICs.
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Affiliation(s)
- Adrina Zhong
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, Canada
| | - Benedict Darren
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bethina Loiseau
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Li Qun Betty He
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.,Michael G. DeGroote Medical School, McMaster University, Hamilton, ON, Canada
| | - Trillium Chang
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Jessica Hill
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Helen Dimaras
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program & The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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9
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Interpretations of autonomous decision-making in antenatal genetic screening among women in China, Hong Kong and Pakistan. Eur J Hum Genet 2018; 26:495-504. [PMID: 29386663 DOI: 10.1038/s41431-017-0091-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/19/2017] [Accepted: 12/23/2017] [Indexed: 12/19/2022] Open
Abstract
The concept of informed choice for antenatal screening consists of Western ideologies, encapsulating individualistic approaches, and may be valued differently by people from countries with more collectivist cultures. This study aimed to explore perceptions of informed choice in antenatal screening in women from China, Hong Kong and Pakistan. A Q-methodology study was conducted during June 2016 to February 2017, in China (Shanghai and Duyun), Hong Kong and Pakistan (Lahore). A total of 299 women rank ordered 41 statements. Following by-person factor analysis, five distinct viewpoints were identified: choice as a maternal responsibility entrusted to doctors; choice as a shared decision led by the mother; choice as a shared decision led by the partner; choice as a responsibility delegated to the partner and doctors; and choice within a religious discourse. The findings highlight ethical dilemmas for healthcare professionals in facilitating informed choice for antenatal screening where policy and practice guidelines adapt predominantly individualistic approaches. Women's preferences for decision-making with health professionals and/or their partner, with minimal emphasis on individual rights, suggest the need for clarification of the role of health professionals in supporting and facilitating decision-making to enhance women's autonomy. Policy and practice guidelines need to be (re)framed to facilitate decision-making processes for antenatal screening using relational approaches to autonomy.
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10
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Tsai GJ, Cameron CA, Czerwinski JL, Mendez-Figueroa H, Peterson SK, Noblin SJ. Attitudes Towards Prenatal Genetic Counseling, Prenatal Genetic Testing, and Termination of Pregnancy among Southeast and East Asian Women in the United States. J Genet Couns 2017; 26:1041-1058. [PMID: 28251433 DOI: 10.1007/s10897-017-0084-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 02/14/2017] [Indexed: 02/03/2023]
Abstract
Recognizing the heterogeneity of the Asian population with regards to acculturation, education, health awareness, and cultural values is vital for tailoring culturally sensitive and appropriate care. Prior studies show that cultural values influence perceptions of genetics within Asian populations. The reputation of the family unit factors into decisions such as pregnancy termination and disclosure of family medical history, and the nondirective model of American genetic counseling may conflict with the historical Asian model of paternalistic health care. Previous studies also provide conflicting evidence regarding correlations between education, acculturation, age, and awareness and perceptions of genetic testing. The aims of this study were to describe attitudes towards prenatal genetics among Southeast and East Asian women living in the United States for varying amounts of time and to explore sociocultural factors influencing those attitudes. Twenty-three Asian women who were members of Asian cultural organizations in the United States were interviewed via telephone about their attitudes towards prenatal genetic counseling, prenatal genetic testing, and termination of pregnancy. Responses were transcribed and coded for common themes using a thematic analysis approach. Four major themes emerged. In general, participants: (1) had diverse expectations for genetic counselors; (2) tended to weigh risks and benefits with regards to genetic testing decisions; (3) had mixed views on termination for lethal and non-lethal genetic conditions; and (4) identified cultural factors which influenced testing and termination such as lack of available resources, societal shame and stigma, and family pressure. These findings may allow prenatal genetic counselors to gain a richer, more nuanced understanding of their Asian patients and to offer culturally tailored prenatal genetic counseling.
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Affiliation(s)
- Ginger J Tsai
- Genetic Counseling Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA. .,Department of Internal Medicine, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Carrie A Cameron
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer L Czerwinski
- Genetic Counseling Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Services, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology, and Reproductive Services, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan K Peterson
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Jane Noblin
- Genetic Counseling Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Services, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
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11
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Barrett AN, Advani HV, Chitty LS, Su LL, Biswas A, Tan WC, Hill M, Choolani M. Evaluation of preferences of women and healthcare professionals in Singapore for implementation of noninvasive prenatal testing for Down syndrome. Singapore Med J 2016; 58:298-310. [PMID: 27357315 DOI: 10.11622/smedj.2016114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Invasive prenatal diagnosis (IPD) has long been used to prenatally diagnose Down syndrome (DS), but it is associated with a small risk of miscarriage. Noninvasive prenatal testing (NIPT) is a highly sensitive screening test using cell-free DNA in maternal blood for detection of DS without the risk of miscarriage, but it confers a small risk of false-positive and false-negative results. The implementation of these procedures into clinical practice requires an understanding of stakeholder preferences. METHODS A total of 69 health professionals (HPs) and 301 women took part in a discrete choice experiment (DCE) in which preferences for four prenatal test attributes - accuracy, time of results, risk of miscarriage and amount of information provided - were assessed. Conditional logit regression was used to analyse the data. Data on demographics and ranked preferences for test attributes was collected, and a direct choice question regarding NIPT, IPD or neither test was posed to participants. RESULTS The women showed a preference for test safety, whereas HPs prioritised test accuracy above all other attributes. When offered a direct choice of NIPT, IPD or neither test, women aged 35 years and older, those with previous miscarriage or who knew a child with DS were more likely to choose NIPT. Chinese women preferred NIPT, whereas Indian women preferred IPD. CONCLUSION Our data highlights the need for patient-specific counselling, taking into account previous experiences and cultural factors. Since women and HPs prioritise different test attributes, it is essential that HPs recognise these differences in order to provide non-biased counselling.
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Affiliation(s)
| | - Henna Vishal Advani
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, United Kingdom
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Wei Ching Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, United Kingdom
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.,Department of Obstetrics and Gynaecology, National University Hospital, Singapore
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12
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13
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Hill M, Johnson JA, Langlois S, Lee H, Winsor S, Dineley B, Horniachek M, Lalatta F, Ronzoni L, Barrett AN, Advani HV, Choolani M, Rabinowitz R, Pajkrt E, van Schendel RV, Henneman L, Rommers W, Bilardo CM, Rendeiro P, Ribeiro MJ, Rocha J, Bay Lund IC, Petersen OB, Becher N, Vogel I, Stefánsdottir V, Ingvarsdottir S, Gottfredsdottir H, Morris S, Chitty LS. Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals. Eur J Hum Genet 2015; 24:968-75. [PMID: 26577044 DOI: 10.1038/ejhg.2015.249] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/06/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants' stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women's and 1245 health professionals' questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women's and health professionals' preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo-Ann Johnson
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Lee
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Winsor
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Brigid Dineley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Marisa Horniachek
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Ronzoni
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Angela N Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Henna V Advani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ron Rabinowitz
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Eva Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rachèl V van Schendel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Wieke Rommers
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - José Rocha
- CGC Genetics, Porto, Portugal.,IINFACTS, CESPU, Porto, Portugal
| | | | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Naja Becher
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Vigdis Stefánsdottir
- Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigrun Ingvarsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Helga Gottfredsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Stephen Morris
- Research Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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14
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Våga BB, Moland KM, Evjen-Olsen B, Blystad A. Reflections on informed choice in resource-poor settings: The case of infant feeding counselling in PMTCT programmes in Tanzania. Soc Sci Med 2014; 105:22-9. [DOI: 10.1016/j.socscimed.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 01/01/2014] [Accepted: 01/04/2014] [Indexed: 10/25/2022]
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15
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Crombag NM, Bensing JM, Iedema-Kuiper R, Schielen PC, Visser GH. Determinants affecting pregnant women’s utilization of prenatal screening for Down syndrome: a review of the literature. J Matern Fetal Neonatal Med 2013; 26:1676-81. [DOI: 10.3109/14767058.2013.798289] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Women's Attitudes towards the Option to Choose between Karyotyping and Rapid Targeted Testing during Pregnancy. Obstet Gynecol Int 2013; 2013:636459. [PMID: 23737796 PMCID: PMC3657422 DOI: 10.1155/2013/636459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/07/2013] [Accepted: 04/11/2013] [Indexed: 11/17/2022] Open
Abstract
Objectives. Pregnant women, referred because of an increased risk of fetal Down syndrome, who underwent an invasive prenatal procedure were offered a choice between karyotyping and rapid targeted testing. This study aims to assess women's attitudes and experiences towards what option to choose. Methods. A retrospective multicentre survey (2008–2010) was conducted among 1370 women. General questions were asked about decision making issues, followed by personal questions about their experiences in choice making, test preference, influence of others, and possible regrets. Results. In total, 90.1% of the respondents (N = 825) indicated that pregnant women are able to choose, although 33.1% stated that the choice can best be made by a professional. 18.4% indicated that making a choice places a burden on women. In 96.4%, respondents preferred to have the option to choose again in case of a next pregnancy, whereas 2.7% preferred the choice to be made by a professional. Regret was indicated by 1.2%. Decision making was influenced by others in 64.9%. A slightly higher preference for karyotyping was indicated by 52.7% of the respondents. Conclusions. Positive attitudes and experiences were expressed towards the option to choose. Respondents took decisions freely, although sometimes influenced by a partner or a professional, to follow their individual perspectives.
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17
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Yotsumoto J, Sekizawa A, Koide K, Purwosunu Y, Ichizuka K, Matsuoka R, Kawame H, Okai T. Attitudes toward non-invasive prenatal diagnosis among pregnant women and health professionals in Japan. Prenat Diagn 2012; 32:674-9. [DOI: 10.1002/pd.3886] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Keiko Koide
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Yuditiya Purwosunu
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Hiroshi Kawame
- Department of Genetic Counseling; Ochanomizu University Graduate School of Humanities and Sciences; Tokyo; Japan
| | - Takashi Okai
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo; Japan
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18
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Ahmed S, Bryant LD, Tizro Z, Shickle D. Is advice incompatible with autonomous informed choice? Women's perceptions of advice in the context of antenatal screening: a qualitative study. Health Expect 2012; 17:555-64. [PMID: 22512856 DOI: 10.1111/j.1369-7625.2012.00784.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient autonomy in antenatal screening is a high priority for policy developers in many countries. OBJECTIVE This paper presents women's understandings of how health professionals should facilitate informed screening choices with an emphasis on their understandings of autonomy and advice. DESIGN, SETTING AND PARTICIPANTS The study was carried out in 2009 in the UK, using a qualitative approach. Ninety-eight participants of African, British White, Caribbean, Chinese and Pakistani origin had semi-structured interviews, which were analysed using framework analysis. RESULTS Four themes were identified during the analysis: 'Meanings of advice in antenatal screening: the advice continuum', 'Recognition of the role of health professionals in decision making', 'Understandings of advice in the context of autonomous decision making' and 'Reasons given for wanting advice'. Women said they valued advice from health professionals to make decisions about antenatal screening, but their understandings of 'advice' ranged from information giving only to direction about screening choices. CONCLUSION Many women wanted health professionals to support the process of making informed choices by engaging in discussion and did not see advice as incompatible with making autonomous choices. However, some women wanted direction about whether to have a screening test or not, something which policy and guidelines explicitly prohibit. This may cause an ethical dilemma for health professionals who are required to both support women's preference for care and adhere to a policy of non-directiveness. Further clarification is needed on how health professionals should support the process of making informed choices when women ask for clear direction on screening choices.
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Affiliation(s)
- Shenaz Ahmed
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, LeedsFaculty of Health & Life Sciences, York St John University, Lord Mayor's Walk, York, UK
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19
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Murakami K, Tsujino K, Sase M, Nakata M, Ito M, Kutsunugi S. Japanese women's attitudes towards routine ultrasound screening during pregnancy. Nurs Health Sci 2012; 14:95-101. [PMID: 22303983 DOI: 10.1111/j.1442-2018.2011.00670.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because there are few published studies from Eastern countries concerning women's experiences of prenatal ultrasound scans, this study investigated this topic in 238 Japanese women in three different prenatal settings. A cross-sectional questionnaire of 33 items was administered to 261 women at 14-37 weeks gestation with no known obstetrical risk, after their ultrasounds. The main reasons for the ultrasounds were evaluation of fetal growth (100%, n = 238); obstetrical conditions (n = 228, 96%); and fetal abnormalities (91%, n = 217). With increasing maternal age, participants worried more about obstetric problems or fetal abnormalities. Many were interested in fetal viability in early pregnancy, and obstetric problems or fetal abnormality in late pregnancy. While most (n = 234, 98%) looked forward to having scans, the majority (n = 235, 99%) wanted to know if their baby had an anomaly, and 72% (n = 171) worried about the detection of abnormalities. Only 50% (n = 118) had obtained information from their care provider. To assist with women's decision-making, prenatal care providers should provide quality information and understand the factors that influence women's concerns.
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Affiliation(s)
- Kyoko Murakami
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
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20
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Choi H, Van Riper M, Thoyre S. Decision making following a prenatal diagnosis of Down syndrome: an integrative review. J Midwifery Womens Health 2012; 57:156-64. [PMID: 22432488 DOI: 10.1111/j.1542-2011.2011.00109.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prenatal screening for Down syndrome (DS) is a routine part of prenatal care in many countries, and there is growing interest in the choices women make following a prenatal diagnosis of DS. This review describes what is known about actual and hypothetical decision making following a prenatal diagnosis of DS and adds understanding about the factors that influence women's decision making. METHODS A search of empirical studies was conducted through electronic databases, major journals, and reference lists that were published in English between January 1999 and September 2010. Inclusion criteria were that the research explored attitudes toward continuation of pregnancy or induced abortion for DS and included at least 1 variable that explored factors influencing women's decision making following a prenatal diagnosis of DS. Studies that did not specify DS, unpublished manuscripts, review articles, and book chapters were excluded. RESULTS A total of 11 studies were identified that met the inclusion criteria. The decision to undergo an induced abortion varied depending on whether participants were prospective parents recruited from the general population (23%-33% would terminate), pregnant women at increased risk for having a child with DS (46%-86% would terminate), or women who received a positive diagnosis of DS during the prenatal period (89%-97% terminated). Multiple factors influence women's decision making following a diagnosis of DS, including demographic factors such as religion, maternal age, gestational age, number of existing children, and history of induced abortion. Psychosocial factors including perceived parenting burden/reward, quality of life for a child with DS, attitudes toward and comfort with individuals with disabilities, and support from others also are important influences. DISCUSSION Multiple factors influence the decisions pregnant women make following the diagnosis of fetal DS. Therefore, it is critical that health care providers who work with pregnant women are aware of these factors.
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Affiliation(s)
- Hyunkyung Choi
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599-7460, USA.
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21
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Schoonen M, van der Zee B, Wildschut H, de Beaufort I, de Wert G, de Koning H, Essink-Bot ML, Steegers E. Informing on prenatal screening for Down syndrome prior to conception. An empirical and ethical perspective. Am J Med Genet A 2012; 158A:485-97. [PMID: 22302760 DOI: 10.1002/ajmg.a.35213] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 11/23/2011] [Indexed: 11/09/2022]
Abstract
In most Western countries, information on prenatal screening for Down syndrome is provided in the first-trimester of pregnancy. The purpose of this study was to examine whether this information should additionally be provided before pregnancy to improve the informed decision-making process. In an empirical study, we obtained data from pregnant women with respect to their preferences regarding information on prenatal screening preconceptionally. Questionnaire data (n = 510) showed that 55.7% of responding women considered participating in prenatal screening for Down syndrome before pregnancy. 28.0% of women possessed information on prenatal screening preconceptionally. 84.6% preferred not to receive information preconceptionally in retrospect. In an ethical analysis, we elaborated on these preferences by weighing pros and cons. We considered two arguments against the provision of information on prenatal screening preconceptionally: women's preference to receive information in a step-by-step manner, and the risk of providing a directive message. We identified three reasons supporting its provision preconceptionally: the likelihood of making an informed decision could, firstly, be increased by "unchaining" the initial information from possible subsequent decisions, and, secondly, by providing women sufficient time to deliberate. Thirdly, the probability of equal access to prenatal screening may increase. To conclude with, we propose to incorporate an information offer on prenatal screening for Down syndrome in preconception care consultations. By offering information, instead of providing information, prospective parents are enabled to either accept or decline the information, which respects both their right to know and their right not-to-know.
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Affiliation(s)
- Marleen Schoonen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Interpretations of informed choice in antenatal screening: a cross-cultural, Q-methodology study. Soc Sci Med 2012; 74:997-1004. [PMID: 22326381 DOI: 10.1016/j.socscimed.2011.12.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 10/18/2011] [Accepted: 12/06/2011] [Indexed: 11/22/2022]
Abstract
Informed choice is internationally recognised and accepted as an important aspect of ethical healthcare. In the U.K., NHS antenatal screening policies state that their primary aim is to facilitate reproductive informed choices. These policies, implemented within a multiethnic population, are largely guided by the ethical principle of autonomy. This study was carried out in 2009 in the U.K. and used Q-methodology to explore diversity in the value attached to autonomous informed choice in antenatal screening for genetic disorders and similarities and differences in this value in women from different ethnic origins. Ninety-eight participants of African, British White, Caribbean, Chinese and Pakistani origin completed a 41-statement Q-sort in English, French, Mandarin or Urdu. Q-Factor analysis produced five statistically independent viewpoints of the value of informed choice: choice as an individual right; choice informed by religious values; choice as a shared responsibility; choice advised by health professionals; and choice within the family context. The findings show that women hold a variety of views on the nature of informed choice, and that, contradictory to policies of autonomous informed choice, many women seek and value the advice of health professionals. The findings have implications for the role of health professionals in facilitating informed choice, quality of care and equity of access.
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Lichtenbelt KD, Alizadeh BZ, Scheffer PG, Stoutenbeek P, Schielen PCJI, Page-Christiaens LCML, Schuring-Blom GH. Trends in the utilization of invasive prenatal diagnosis in The Netherlands during 2000-2009. Prenat Diagn 2011; 31:765-72. [PMID: 21692084 DOI: 10.1002/pd.2764] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/22/2011] [Accepted: 03/24/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze trends in the number and type of invasive procedure, reasons for referral, maternal age and chromosomal abnormalities over a 10-year period and correlate the trends to changes in the national prenatal screening policy. METHODS Data from 10 706 invasive prenatal procedures yielding a full karyotype, performed between 2000 and 2009 were extracted from the cytogenetic database in the central region of The Netherlands. Trends were analyzed. RESULTS Over a 10-year period, the number of invasive procedures halved and the percentage of chromosomal abnormalities detected, increased from 5.5 to 9.4%. After 2007, however, 5.7% of karyotypes in women over 36 years were found to be abnormal, versus 18.1% in women below 36 years. In 2009, 71.5% of women over 36 are still referred for invasive prenatal diagnosis on the indication advanced maternal age. CONCLUSIONS Changes in prenatal screening policy significantly increased referral after screening and improved the efficacy of invasive prenatal diagnosis. We show the continuing effect of the different policies applied in the past to women below and above the age of 36. To further improve efficacy of invasive prenatal diagnosis, first trimester combination screening should be actively offered to women of all ages.
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Affiliation(s)
- Klaske D Lichtenbelt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
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