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Zhao Y, Xue Z, Geng Y, Zhu J, Hu M, Jiang M. Understanding knowledge, perception, and willingness of non-invasive prenatal testing for fetal aneuploidy: a survey among Chinese high-risk pregnant women. Front Med (Lausanne) 2023; 10:1232942. [PMID: 37908853 PMCID: PMC10613663 DOI: 10.3389/fmed.2023.1232942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Non-invasive prenatal testing (NIPT) is utilized for screening the likelihood of fetal aneuploidy, presenting the benefits of non-invasiveness, high sensitivity, and specificity. Its application in prenatal screening has become ubiquitous. The inquiry into how pregnant women comprehend and determine NIPT screening strategies is paramount. Regrettably, there has been a dearth of research on this subject in China. Consequently, this study scrutinizes pregnant women's cognizance and perspectives concerning NIPT, furnishing a foundation for advancing its judicious implementation. Methods From February 2021 to December 2022, a questionnaire survey was conducted among pregnant women receiving prenatal care and screening at the Women's Hospital, School of Medicine, Zhejiang University, who were randomly selected from a pool of individuals exhibiting a high risk of fetal aneuploidy on serological screening. The survey aimed to gather data on participant characteristics, knowledge, perception, and willingness concerning NIPT. The study employed chi-square and Kruskal Wallis tests to analyze subgroup differences. Results A total of 226 valid questionnaires were obtained. 83.2% of women pregnant women identified as high risk by serological screening would opt for NIPT, with 66.4% indicating that they would prefer NIPT for fetal aneuploidy screening in future pregnancies. These findings suggest a notable willingness among pregnant women to undergo NIPT. Additionally, the results suggest that various factors, including place of residence, educational level, family income, causes of abortion, and conception method, influence pregnant women's knowledge about NIPT Accordingly, the level of NIPT knowledge varies among pregnant women. Conclusion The survey generally revealed that pregnant women were strongly inclined to select NIPT; however, expectant Chinese mothers possess limited knowledge and perception regarding this screening method for fetal aneuploidy. Therefore, the government must implement effective measures to augment public awareness of fetal aneuploidy screening and encourage the judicious utilization of NIPT.
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Affiliation(s)
- Yi Zhao
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhu Xue
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yarui Geng
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Zhu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Maidan Hu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Minmin Jiang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
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McInerney J, Lombardo P, Cowling C, Roberts S, Sim J. Australian sonographers' perceptions of patient safety in ultrasound imaging: Part two - translation into practice. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:186-194. [PMID: 37538968 PMCID: PMC10395386 DOI: 10.1177/1742271x221131282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 08/05/2023]
Abstract
Introduction A lack of patient safety research hampers capacity to improve safety in healthcare.Ultrasound is often considered 'safe' as it does not use ionising radiation, a simplistic view of patient safety. Understanding sonographers' actions towards patient safety is crucial; however, self-reported measures cannot always predict behaviour. This study is part of a PhD exploring patient safety in medical diagnostic ultrasound. The aim of this paper is to explore sonographers' responses to the patient safety concerns identified in Part one of this study. The ultimate aim of the study is to inform the final phase of the doctoral study which will consider the next steps in improving the quality and safety of healthcare experienced by patients. Methods A qualitative study using semi-structured, one-on-one interviews. The Theory of Planned Behaviour (TPB) explained how sonographers respond to perceived patient safety risks in practice. Results Thirty-one sonographers were interviewed. Based on the seven themes identified in Part one of the study, results showed that incongruences exist between identifying patient safety risks and the actions taken in practice to manage these risks. Conclusion The TPB showed that behavioural, normative and control beliefs impact sonographers' responses to perceived patient safety risks in practice and can lead to risk avoidance. Lack of regulation in ultrasound creates a challenge in dealing with Fitness to Practice issues. Collective actions are required to support sonographers in taking appropriate actions to enhance patient safety from multiple stakeholders including accreditation bodies, regulatory authorities, educational institutions and employers.
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Affiliation(s)
| | | | | | | | - Jenny Sim
- Monash University, Clayton, VIC, Australia
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Starcevich A, Lombardo P, Schneider M. Patient understanding of diagnostic ultrasound examinations in an Australian private radiology clinic. Australas J Ultrasound Med 2021; 24:82-88. [PMID: 34765415 DOI: 10.1002/ajum.12237] [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: 04/03/2020] [Revised: 09/16/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
Purpose To determine patient understanding and expectations of ultrasound imaging and its safety, sources of examination information and levels of examination anxiety. Methods 1070 consecutive patients presenting to a private, regional radiology practice in New South Wales, Australia between 16th May and 14th June 2019, were invited to complete a survey while waiting for their non-interventional ultrasound examination. The survey included questions on demographic characteristics, knowledge such as examination risks and safety, ultrasound expectations such as dissemination of results, sources of examination information and levels of participant anxiety. Data were analysed using Kruskal-Wallis tests (SPSS v. 25) to determine statistical associations between participant demographic factors, knowledge, anxiety level and the main source of examination information. Results A total of 215/1070 (20%) patients voluntarily participated in the study. Most were female (74%, 159/215), with a median (range) age of 55 (18-92) years. Participant's median (range) score of ultrasound imaging knowledge was 3 (0-5) scored out of six and indicated uncertainty regarding the ultrasound procedure, result dissemination and ultrasound safety. Participants with previous personal experience had significantly higher levels of ultrasound imaging knowledge than those whose primary information source was their referring doctor (P = 0.0005) or the internet (P = 0.026). Significantly higher levels of ultrasound examination knowledge were also associated with lower self-reported levels of anxiety (P = 0.002). Conclusion Participants had incomplete ultrasound examination knowledge, including misconceptions regarding safety and result dissemination, some of which could be clarified by the sonographer at the beginning of the ultrasound examination.
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Affiliation(s)
- Amy Starcevich
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
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Anselem O, Saurel-Cubizolles MJ, Khoshnood B, Blondel B, Sauvegrain P, Bertille N, Azria E. Does women's place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France. BMC Pregnancy Childbirth 2021; 21:590. [PMID: 34461849 PMCID: PMC8406966 DOI: 10.1186/s12884-021-04041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background To examine disparities by maternal place of birth in the opportunity to make an informed choice about Down syndrome screening, in France, where the national guidelines recommend that physicians offer it to all pregnant women. Methods We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator. Results Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and the maternity unit’s level of perinatal care, women born outside France had the opportunity to make an informed choice less often than women born in France. This association remained essentially the same even after excluding women without adequate prenatal care. Conclusions Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.
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Affiliation(s)
- Olivia Anselem
- Maternité Port-Royal, APHP.Centre-Université de Paris, FHU PREMA, 123 boulevard de Port-Royal, 75014, Paris, France.
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Babak Khoshnood
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Université Paris, Paris, France
| | - Nathalie Bertille
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France
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Igel CM, Rabin-Havt S, Estrada Trejo F, Doulaveris G, Eisenberg R, Fazzari M, Klugman S. Patient attitudes toward prenatal diagnostic testing during antenatal care in an urban population. Prenat Diagn 2021; 41:888-895. [PMID: 33470437 DOI: 10.1002/pd.5899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Investigate factors that influence the decision to accept or decline diagnostic testing for pregnant women referred for genetic counseling. METHODS Cross sectional anonymous survey of pregnant women undergoing genetic counseling at a tertiary care referral center. Subjects' perceived risk of procedure related loss and fetal chromosomal problem were obtained via survey where patients rated risk from 0 (no risk) to 10 (highest risk). RESULTS There were no differences in sociodemographic factors between women undergoing a diagnostic procedure compared to those not undergoing a procedure. As the perceived risk for having a baby with genetic problem increased by one point, the estimated odds of having the diagnostic procedure increased by 43% controlling for the perceived risk of procedure related loss (p < .0001). Similarly, as the perceived risk of miscarriage increased by one point, the odds of having the diagnostic procedure decreased by 40%, controlling for the perceived risk of having a baby with a genetic problem (p < .0001). The main reason women cited for not undergoing a procedure was fear of procedure related loss. CONCLUSIONS Pregnant women that decline diagnostic testing have a higher perceived risk of procedure related loss and lower perceived risk of fetal chromosomal abnormality than those who accept.
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Affiliation(s)
- Catherine M Igel
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Sara Rabin-Havt
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Fatima Estrada Trejo
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Georgios Doulaveris
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Ruth Eisenberg
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Melissa Fazzari
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA.,Department of Epidemiology & Population Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Susan Klugman
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
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Prenatal tests for chromosomal abnormalities detection (PTCAD): pregnant women's knowledge in an Italian Population. Arch Gynecol Obstet 2020; 303:1185-1190. [PMID: 33111167 DOI: 10.1007/s00404-020-05846-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Nowadays several Prenatal Tests for Chromosomal Abnormalities Detection (PTCAD) are available. In those cases in which there is not an Institutional protocol to advise women about the available PTCAD, the choice of which one to undergo is up to the woman and largely depends on her knowledge about them. Therefore, we decided to evaluate, as a primary outcome, knowledge about PTCAD among pregnant women attending our Term Clinic. As a secondary outcome we evaluated the relationship between the patient's knowledge and the subsequently chosen PTCAD. METHODS From August 2017 to August 2018 an anonymous questionnaire with multiple-choice answers was administered to all pregnant women attending our Term antenatal Clinic, a tertiary obstetric unit in Catanzaro (Italy). RESULTS Three hundred and twenty-five pregnant women were enrolled in the study. We observed that 28.8% of the pregnant women that chose one of the PTCAD, avoided the first trimester combined screening test; among these, 11.4% were in favour of the cell-free foetal DNA test. The latter was erroneously considered diagnostic by 34.3% of the women that had chosen it. CONCLUSIONS This study demonstrated that women's knowledge about PTCAD is poor and that there is a potentially dangerous confusion between the words 'screening' and 'diagnostic'. Informative campaigns about PTCAD and the application of dedicated antenatal counselling appointments should be a health-care priority to avoid unnecessary risks and costs for pregnant women and possible legal issues.
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Pierre F. [Woman's information and consent in obstetrics: CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:986-993. [PMID: 30385356 DOI: 10.1016/j.gofs.2018.10.025] [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: 10/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze literature, rules, and practices concerning woman's information on labour and delivery. METHODS An actualized systematic review of French rules and guidelines, as well as literature, on patient's information, shared decision-making, and patient's autonomy was done. RESULTS After a reminder on basis of patient's information, notions on patient's autonomy, consent to care, and shared decision-making are developed. Lastly, the role of information documents and birth plan are clarified, as well as rules and guidelines for an efficient conception of the information documents that will result from the present clinical practice guidelines on perineal prevention and protection in obstetrics. CONCLUSION During pregnancy, and again in the labour room, it is recommended to focus on the woman's expectations and to inform her about the modes of delivery. Because she has seen several healthcare professionals during pregnancy, it is necessary to inquire about the information she has already received in order to adapt further information to her situation and current knowledge. This information can be delivered in several forms and by several sources; it should be completed by individualized oral information provided by the healthcare professionals attending her during her prenatal care and during labour. If the woman wants to develop a birth plan, it should be constructed in a supported process that allows the sharing of her knowledge and expectations and of appropriate information delivered by professionals, ideally beginning with the early prenatal interview and continuing during antenatal consultations and sessions of preparation for childbirth and parenting.
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Affiliation(s)
- F Pierre
- Service de gynécologie obstétrique et médecine de la reproduction, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, CS 90577, 86021 Poitiers cedex, France.
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Murdoch B, Ravitsky V, Ogbogu U, Ali-Khan S, Bertier G, Birko S, Bubela T, De Beer J, Dupras C, Ellis M, Granados Moreno P, Joly Y, Kamenova K, Master Z, Marcon A, Paulden M, Rousseau F, Caulfield T. Non-invasive Prenatal Testing and the Unveiling of an Impaired Translation Process. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:10-17. [DOI: 10.1016/j.jogc.2016.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/29/2016] [Indexed: 12/15/2022]
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Smith SK, Sousa MS, Essink-Bot ML, Halliday J, Peate M, Fransen M. Socioeconomic Differences in Informed Decisions About Down Syndrome Screening: A Systematic Review and Research Agenda. JOURNAL OF HEALTH COMMUNICATION 2016; 21:868-907. [PMID: 27410478 DOI: 10.1080/10810730.2016.1177145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Supporting pregnant women to make informed choices about Down syndrome screening is widely endorsed. We reviewed the literature on: (a) the association between socioeconomic position and informed choices and decision-making about Down syndrome screening, and (b) the possible mediating variables (e.g., health literacy, numeracy skills, behavioral and communication variables) that might explain the relationship. EMBASE, MEDLINE, PubMed, CINAHL, and PsycINFO were searched from January 1999 to September 2014. The methodological quality of studies was determined by predefined criteria regarding the research aims, study design, study population and setting, measurement tools, and statistical analysis. A total of 33 studies met the inclusion criteria. Women from lower socioeconomic groups experience greater difficulties making informed choices about Down syndrome screening compared to women from higher socioeconomic groups. Most studies focus on individual dimensions of informed decision-making rather than assessing elements in conjunction with one another. Few studies have explored why there are socioeconomic differences in women's ability to make informed screening decisions. Future work is needed to identify mediating variables in this pathway. Systematic evidence-based intervention development to improve communication, understanding, and decision-making about Down syndrome screening is needed to ensure that women have an equal opportunity to make an informed choice about screening regardless of their socioeconomic position.
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Affiliation(s)
- Sian K Smith
- a Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine , University of New South Wales , Sydney , New South Wales , Australia
| | - Mariana S Sousa
- b Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
- c Prince of Wales Clinical School , University of New South Wales , Sydney , New South Wales , Australia
| | - Marie-Louise Essink-Bot
- d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
| | - Jane Halliday
- e Murdoch Children's Research Institute , Royal Children's Hospital , Melbourne , Victoria , Australia
- f Department of Paediatrics , University of Melbourne , Parkville , Victoria , Australia
| | - Michelle Peate
- g Department of Obstetrics and Gynaecology, Royal Women's Hospital , University of Melbourne , Parkville , Victoria , Australia
| | - Mirjam Fransen
- d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
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Kou KO, Poon CF, Tse WC, Mak SL, Leung KY. Knowledge and future preference of Chinese women in a major public hospital in Hong Kong after undergoing non-invasive prenatal testing for positive aneuploidy screening: a questionnaire survey. BMC Pregnancy Childbirth 2015; 15:199. [PMID: 26330276 PMCID: PMC4557816 DOI: 10.1186/s12884-015-0636-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/24/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the non-invasive nature of non-invasive prenatal testing (NIPT), there is still a need for a separate informed consent process before testing. The objectives of this study are to assess (a) knowledge and preferences of Chinese women in a major public hospital in Hong Kong who underwent NIPT, and (b) whether their knowledge and preferences differ depending on womens' characteristics and sources of information. METHODS Setting: Prenatal diagnosis and counselling clinic. Between February 2012 and September 2013, a questionnaire survey was distributed to all women who underwent NIPT after positive aneuploidy screening. As a pilot study, ten knowledge questions were designed based on the rapid response statement on Prenatal Detection of Down Syndrome using Massively Parallel Sequencing from the International Society for Prenatal Diagnosis in 2011. The source of women's knowledge and their preferences were also evaluated. While conventional screening was publicly funded, NIPT was not. Differences between subgroups were compared using chi square tests and logistic regression analysis. RESULTS Of 152 women who underwent NIPT, 135 (88.8%) completed their questionnaires. More than 90% of women recognised the possibility of false positive and false negative results. Slightly more than 70% of women knew the inferior sensitivity of NIPT compared to an invasive test, and the possibility of an uninformative test result, but were not aware of the complicated aspects of NIPT. Pregnant women with an advanced level of education or those who underwent NIPT before 15 weeks provided answers that was more accurate by around 10-20% in two to three knowledge questions than those without. These associations were confirmed by multivariate logistic regression analysis. The women received information on NIPT largely from their private doctors (47.4%) and web (41.5%). In their future pregnancies, more women would opt for NIPT (a self-financed item) after positive screening ('free' in a public hospital) (57.8%) than as a primary screening (30.4%). CONCLUSIONS It is feasible to use a questionnaire based on the ISPD statement on NIPT to assess women's knowledge of the test. The Chinese women who underwent NIPT recognised the limitations, but did not understand the complicated aspects. More information should be provided by health care professionals in order to facilitate an informed choice by patients. More women preferred NIPT as a contingent test than as a primary screening probably because of its high cost.
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Affiliation(s)
- Kam On Kou
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Chung Fan Poon
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Wai Ching Tse
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Shui Lam Mak
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
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Minear MA, Alessi S, Allyse M, Michie M, Chandrasekharan S. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues. Annu Rev Genomics Hum Genet 2015; 16:369-98. [DOI: 10.1146/annurev-genom-090314-050000] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mollie A. Minear
- Duke Science & Society, Duke University, Durham, North Carolina 27708
| | - Stephanie Alessi
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, California 94305
| | - Megan Allyse
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota 55905
| | - Marsha Michie
- Institute for Health and Aging, University of California, San Francisco, California 94143
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[Assessment of patients' knowledge of first-trimester combined Down syndrome screening at the time of their first trimester ultrasonographic evaluation: Results of a prospective study about 201 women]. ACTA ACUST UNITED AC 2015; 45:62-70. [PMID: 25869443 DOI: 10.1016/j.jgyn.2015.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Assess pregnant women's knowledge on first-trimester combined Down syndrome screening, at the time of their first trimester ultrasound scan. MATERIALS AND METHODS A questionnaire was submitted to the patients coming for their 12-week pregnancy ultrasonographic evaluation in a University Hospital prenatal clinic between May 2012 and May 2013. Correct and incorrect statements on Down syndrome screening were proposed to the mothers who were asked to rate them. Each patient was questioned on her prior exposition to Down syndrome screening, the category of medical of professional she previously consulted, and the information she received. Patients' knowledge was evaluated according to these criteria. RESULTS Two hundred and one patients were included in this study. The average correct answer rating was 4.6 (out of 8 questions). The average incorrect answer rating was 2.4 (out of 6 questions). No difference was found between the different social and demographic groups, nor according to the category of professional consulted before the first ultrasound scan. Higher correct answer ratings were observed when the patient had already been submitted to a Down syndrome screening (P=0.039), when they had previously received explanations about the screening (P=0.003); and when they stated that they had been sufficiently informed (P=0.042). CONCLUSION These results show that patients' knowledge on Down syndrome screening is inadequate and depends on their experience of previous screening and information. It is deemed necessary to improve information especially to young women who are pregnant for the first time.
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Marx-Deseure A, Carpentier S, Thomas D, Bouquillon S, Delobel B, Bailleux B, Bomy H, Vaast P, Debarge V. [Birth of a child with Down syndrome: parental choice or failure of screening policy?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:284-289. [PMID: 25813435 DOI: 10.1016/j.gyobfe.2015.02.001] [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: 11/30/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Birth of a child with Down syndrome (DS) can follow parental choice or failure of screening. The objective of this work is to describe the circumstances of births of children with DS in a French perinatal health network. METHODS Retrospective multicentric study, with prospective trial registration of all children born alive with DS, between 2010 and 2013. RESULTS Sixty-three children were born with DS. Complete screening was performed by 61 % of patients, incomplete screening by 29 % of patients and no screening test by 10 %. Among these births, 50 % occurred following parental choice, 40 % following failure of screening and for 10 %, parental choice concerning screening was unknown. False negative had often calculating risk close to 1/1000. CONCLUSION In this study, the birth of a child with DS occurred following parental choice in half of cases. It's necessary, to optimize the follow-up, to document in medical records the medical information and parental choice concerning DS screening and data of screening when this was done.
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Affiliation(s)
- A Marx-Deseure
- Pôle d'obstétrique, CHRU de Lille, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - S Carpentier
- Réseau de santé en périnatalité OMBREL, CHRU de Lille, hôpital Jeanne-de-Flandre, 59037 Lille cedex, France
| | - D Thomas
- Pôle pédiatrie, CHRU de Lille, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - S Bouquillon
- Pôle de biopathologie, laboratoire de cytogénétique, CHRU de Lille, 59037 Lille cedex, France
| | - B Delobel
- Laboratoire de génétique, hôpital Saint-Vincent-de-Paul, 59020 Lille, France
| | - B Bailleux
- Réseau de santé en périnatalité OMBREL, CHRU de Lille, hôpital Jeanne-de-Flandre, 59037 Lille cedex, France
| | - H Bomy
- Réseau de santé en périnatalité OMBREL, CHRU de Lille, hôpital Jeanne-de-Flandre, 59037 Lille cedex, France
| | - P Vaast
- Pôle d'obstétrique, CHRU de Lille, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - V Debarge
- Pôle d'obstétrique, CHRU de Lille, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France; Université de Lille 2, 59000 Nord de France, France
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Ames AG, Metcalfe SA, Archibald AD, Duncan RE, Emery J. Measuring informed choice in population-based reproductive genetic screening: a systematic review. Eur J Hum Genet 2015; 23:8-21. [PMID: 24848746 PMCID: PMC4266751 DOI: 10.1038/ejhg.2014.89] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/11/2014] [Accepted: 04/10/2014] [Indexed: 11/09/2022] Open
Abstract
Genetic screening and health-care guidelines recommend that programmes should facilitate informed choice. It is therefore important that accurate measures of informed choice are available to evaluate such programmes. This review synthesises and appraises measures used to evaluate informed choice in population-based genetic screening programmes for reproductive risk. Databases were searched for studies offering genetic screening for the purpose of establishing reproductive risk to an adult population sample, in which aspects of informed choice were measured. Studies were included if, at a minimum, measures of uptake of screening and knowledge were used. Searches identified 1462 citations and 76 studies were reviewed in full text; 34 studies met the inclusion criteria. Over 20 different measures of informed choice were used. Many measures lacked adequate validity and reliability data. This systematic review will inform future evaluation of informed choice in population genetic screening programmes.
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Affiliation(s)
- Alice Grace Ames
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sylvia Ann Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Dalton Archibald
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Rony Emily Duncan
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Health Services Delivery for Adolescents, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jon Emery
- General Practice and Primary Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
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Attitudes towards non-invasive prenatal testing for aneuploidy among US adults of reproductive age. J Perinatol 2014; 34:429-34. [PMID: 24603453 PMCID: PMC4399855 DOI: 10.1038/jp.2014.30] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 01/19/2014] [Accepted: 01/27/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine how adults in the United States view non-invasive prenatal testing using cell-free fetal DNA (cffDNA testing) in order to help estimate uptake. STUDY DESIGN A national sample of 1861 US-based adults was surveyed using a validated online survey instrument. The survey was administered by a commercial survey research company. Respondents were randomized to receive a survey about prenatal testing for trisomy 13 and 18 or trisomy 21. Participants were asked to select among testing modalities, including cffDNA testing, and rank the features of testing that they considered most important to decision making. RESULT There was substantive interest in the use of cffDNA testing rather than traditional screening mechanisms, with a minority of respondents reporting that they would support the use of both methods in combination. The lower rates of false-negative and false-positive test results and the ability to use the test earlier in the pregnancy were the most highly rated benefits of cffDNA testing. Participants expressed strong support for diagnostic confirmation via invasive testing after a positive result from either screening or cffDNA testing. However, almost one-third of participants reported that they would not endorse the use of either invasive or non-invasive prenatal testing. CONCLUSION There appears to be support for uptake of non-invasive prenatal tests. Clinical guidelines should therefore go forward in providing guidance on how to integrate non-invasive methods into the current standard of care. However, our findings indicate that even when accuracy, which is rated by patients as the most important aspect of prenatal testing, is significantly improved over existing screening methods and testing is offered non-invasively, the number of individuals who reported that they would decline any testing remained the same. Attention should therefore be directed at ensuring that the right of informed refusal of prenatal testing is not impacted by new, non-invasive methods.
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Bakker M, Pajkrt E, Bilardo CM. Increased nuchal translucency with normal karyotype and anomaly scan: What next? Best Pract Res Clin Obstet Gynaecol 2014; 28:355-66. [DOI: 10.1016/j.bpobgyn.2013.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 09/23/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022]
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Constantine ML, Allyse M, Wall M, Vries RD, Rockwood TH. Imperfect informed consent for prenatal screening: Lessons from the Quad screen. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1477750913511339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The study evaluated patient informed consent (IC) for the Quad screen and examined differences in IC between test acceptors and test refusers. A multidimensional model of IC was used. Methods Women seeking prenatal care at nine obstetrics clinics in a large Midwestern city completed surveys between February and December 2006. Surveys contained measures for three dimensions of IC: intention, understanding and controlling influence. Results 56.2% of women did not meet criteria for all three of our dimensions of IC and therefore failed to give it. The failure rate was higher among women who choose to screen (72.6%) than women who choose not screen (50%) (p < 0.001). Women who met all criteria for IC were over three times less likley to choose to screen (or = 0.32, CI 0.17–0.62 ( p < 0.01)) than women who did not meet criteria for IC. Conclusion The decision to screen for fetal anomalies is less of a deliberated action than the decision not to screen. Women who lack a fundamental understanding of the purpose and nature of the screen may be operating on the belief that the screen is part of standard care and presents no need to deliberate.
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Affiliation(s)
- ML Constantine
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - M Allyse
- Center for Biomedical Ethics, Stanford University, Stanford, CA, USA
| | - M Wall
- Division of Biostatistics, Department of Psychiatry, Columbia University, New York, NY, USA
| | - R De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Medical Education/Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
- Academie Verloskunde Maastricht/Zuyd University; CAPHRI School for Public Health and Primary Care/Maastricht University, Maastricht, NL
| | - TH Rockwood
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Carroll FE, Al-Janabi H, Flynn T, Montgomery AA. Women and their partners' preferences for Down's syndrome screening tests: a discrete choice experiment. Prenat Diagn 2013; 33:449-56. [DOI: 10.1002/pd.4086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Fran E. Carroll
- School of Social and Community Medicine; University of Bristol; England UK
| | - Hareth Al-Janabi
- Health Economics Unit, School of Health and Population Sciences; University of Birmingham; England UK
| | - Terry Flynn
- Centre for the Study of Choice; University of Technology; Sydney Australia
| | - Alan A. Montgomery
- School of Social and Community Medicine; University of Bristol; England UK
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Deans Z, Hill M, Chitty LS, Lewis C. Non-invasive prenatal testing for single gene disorders: exploring the ethics. Eur J Hum Genet 2012. [PMID: 23188047 DOI: 10.1038/ejhg.2012.250] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Non-invasive prenatal testing for single gene disorders is now clearly on the horizon. This new technology offers obvious clinical benefits such as safe testing early in pregnancy. Before widespread implementation, it is important to consider the possible ethical implications. Four hypothetical scenarios are presented that highlight how ethical ideals of respect for autonomy, privacy and fairness may come into play when offering non-invasive prenatal testing for single gene disorders. The first scenario illustrates the moral case for using these tests for 'information only', identifying a potential conflict between larger numbers of women seeking the benefits of the test and the wider social impact of funding tests that do not offer immediate clinical benefit. The second scenario shows how the simplicity and safety of non-invasive prenatal testing could lead to more autonomous decision-making and, conversely, how this could also lead to increased pressure on women to take up testing. In the third scenario we show how, unless strong safeguards are put in place, offering non-invasive prenatal testing could be subject to routinisation with informed consent undermined and that woman who are newly diagnosed as carriers may be particularly vulnerable. The final scenario introduces the possibility of a conflict of the moral rights of a woman and her partner through testing for single gene disorders. This analysis informs our understanding of the potential impacts of non-invasive prenatal testing for single gene disorders on clinical practice and has implications for future policy and guidelines for prenatal care.
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Affiliation(s)
- Zuzana Deans
- Department of Community Based Medicine, Centre for Ethics in Medicine, University of Bristol, Bristol, UK
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20
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Moutel G. [Why patient consent is not to be neglected?]. ACTA ACUST UNITED AC 2012; 40:698-700. [PMID: 23099022 DOI: 10.1016/j.gyobfe.2012.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/21/2012] [Indexed: 10/27/2022]
Abstract
Observation of medical practices still show that, in some institutions, obtaining consent could be in the mode of a trivialization, or even some administrative automaticity. To ensure a truly informed choice, this article explains why the information in the sensitive field of reproductive medicine and perinatology should remain an act of care and relationship. It outlines why medical information issued to couples must take into account not only validated data, but also the doubts and uncertainties. This is especially true when risk management because the meaning we give to the acceptance of risk is not simply the result of a calcul of probability but also the result of a social construction. All signed consent and collected outside of such an approach to quality and completeness of the information would be considered questionable.
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Affiliation(s)
- G Moutel
- Éthique médicale, université Paris Descartes, unité de médecine sociale, groupe hospitalier Corentin Celton-HEGP, AP-HP, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux cedex, France.
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Dahl K, Hvidman L, Jørgensen FS, Henriques C, Olesen F, Kjaergaard H, Kesmodel US. First-trimester Down syndrome screening: pregnant women's knowledge. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:145-151. [PMID: 20878670 DOI: 10.1002/uog.8839] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The primary aim of this study was to assess pregnant women's knowledge of first-trimester combined Down syndrome screening in a setting of required informed consent. As the secondary aim, we wanted to identify relevant differences in knowledge level among subgroups of pregnant women, including those informed in different ways about prenatal examinations. METHODS Data stem from a population-based cross-sectional questionnaire study including 15 multiple-choice questions assessing knowledge of different aspects of screening. Included were 6427 first-trimester pregnant women from three Danish obstetric departments offering prenatal screening free of charge. Both participants and non-participants in the screening program were included. The results are based on 4095 responders (64%). Differences between subgroups were examined using chi-squared tests and logistic regression analysis. Estimates are stated with 95% CI. RESULTS The majority of the participants (87.6 (86.6-88.6)% to 92.6 (91.7-93.3)%) correctly identified the test concept and the main condition being screened for. Fewer participants (16.4 (15.3-17.6)% to 43.3 (41.8-44.8)%) correctly recognized test accuracy and the potential risk of adverse findings other than Down syndrome. Knowledge level was positively associated with length of education (adjusted ORs 1.0 (0.8-1.4) to 3.9 (2.4-6.4)) and participation in the screening program (adjusted OR 0.9 (0.6-1.3) to 5.9 (3.9-8.8)). Participation in an individual information session was weakly associated with more knowledge. CONCLUSION The majority of the pregnant women correctly identified the test concept and the main condition being screened for. The pregnant women were found less knowledgeable on test accuracy and drawbacks.
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Affiliation(s)
- K Dahl
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.
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Dahl K, Hvidman L, Jørgensen FS, Kesmodel US. Knowledge of prenatal screening and psychological management of test decisions. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:152-157. [PMID: 20954167 DOI: 10.1002/uog.8856] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To study associations between pregnant women's knowledge of prenatal screening and decisional conflict in deciding whether to participate in first-trimester screening for Down syndrome in a setting of required informed consent, and to study associations between knowledge and personal wellbeing, and worries in pregnancy. METHODS A population-based cross-sectional study with 6427 pregnant women consecutively included before the time of a nuchal translucency scan. Participants were recruited from three Danish obstetric departments offering prenatal screening free of charge. The results presented are based on 4111 pregnant women (64%). Knowledge was measured using 15 questions. The primary outcomes were measured using pre-existing validated scales, i.e. The Decisional Conflict Scale, the WHO Well-Being Index and the Cambridge Worry Scale. Associations were analyzed by multivariate logistic and linear regression analyses. RESULTS A higher level of knowledge was associated with less decisional conflict when deciding whether to participate in first-trimester Down syndrome screening (adjusted odds ratio 1.31 (95% CI, 1.26-1.37)). An increased level of knowledge was also associated with higher levels of wellbeing (adjusted linear coefficient 0.51 (95% CI, 0.26-0.75), P < 0.001). Knowledge was not associated with worries, either in general or specifically about something being wrong with the baby. CONCLUSION The results of this study indicate the importance of ensuring a high level of knowledge for pregnant women making choices about participation in prenatal screening for Down syndrome in order to improve the psychological management of test decisions.
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Affiliation(s)
- K Dahl
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark.
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'I want a choice, but I don't want to decide'--a qualitative study of pregnant women's experiences regarding early ultrasound risk assessment for chromosomal anomalies. Midwifery 2010; 28:14-23. [PMID: 21130549 DOI: 10.1016/j.midw.2010.10.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 08/12/2010] [Accepted: 10/29/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To increase our understanding of how pregnant women experience early ultrasound examination that includes a risk assessment for chromosomal anomalies and how such women perceive the test results. DESIGN/SETTING Qualitative study at St. Olavs Hospital in Norway. Both pre- and post-examination interviews were conducted with ten pregnant women who underwent risk assessment for chromosomal anomalies. Grounded theory was used to analyse the results. FINDINGS The study generated a core category (I want a choice, but I don't want to decide), which related to the conflict between choice and decision making. There were also five main categories (existential choices, search for knowledge, anxiety, feeling of guilt and counselling and care). The main categories describe the complex feelings experienced by the women regarding the risk assessment. Factors contributing to the difficulty of choice included loss of control and coping, emotional connection to the fetus and social pressure. As the women sought independent choices without any external influence, they also felt greater responsibility. The women's understanding of the actual risk varied, and they used different types of logic and methods to evaluate the risk and reach a decision. CONCLUSIONS The pregnant women in this study wanted prenatal diagnostic information and easy access to specialty services. Stress-related feelings and non-transparent information about the actual and perceived risks as well as personal moral judgments made the decision-making process complicated. Improved distribution of information and frequent contact with health professionals may help such women to make informed choices in accordance with their values and beliefs.
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Azria E. [Statement of conscience in trisomy 21 screening: pregnant women's free will jeopardized]. ACTA ACUST UNITED AC 2010; 39:592-4. [PMID: 20926207 DOI: 10.1016/j.jgyn.2010.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2010] [Indexed: 11/17/2022]
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25
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Seror V, Ville Y. Women's attitudes to the successive decisions possibly involved in prenatal screening for Down syndrome: how consistent with their actual decisions? Prenat Diagn 2010; 30:1086-93. [DOI: 10.1002/pd.2616] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Simon-Bouy B, Mornet E. [Non-invasive prenatal diagnosis: a tool for the future? Which consequences for our practices?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:435-438. [PMID: 20579924 DOI: 10.1016/j.gyobfe.2010.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Bilardo CM, Timmerman E, Pajkrt E, van Maarle M. Increased nuchal translucency in euploid fetuses--what should we be telling the parents? Prenat Diagn 2010; 30:93-102. [PMID: 20077440 DOI: 10.1002/pd.2396] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development.
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Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit Academic Medical Centre, Amsterdam, The Netherlands.
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28
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Abstract
This paper explores the ethical implications of introducing non-invasive prenatal diagnostic tests (NIPD tests) in prenatal screening for foetal abnormalities. NIPD tests are easy and safe and can be performed early in pregnancy. Precisely because of these features, it is feared that informed consent may become more difficult, that both testing and selective abortion will become 'normalized', and that there will be a trend towards accepting testing for minor abnormalities and non-medical traits as well. In our view, however, the real moral challenge of NIPD testing consists in the possibility of linking up a technique with these features (easy, safe and early) with new genomic technologies that allow prenatal diagnostic testing for a much broader range of abnormalities than is the case in current procedures. An increase in uptake and more selective abortions need not in itself be taken to signal a thoughtless acceptance of these procedures. However, combining this with considerably enlarging the scope of NIPD testing will indeed make informed consent more difficult and challenge the notion of prenatal screening as serving reproductive autonomy. If broad NIPD testing includes later-onset diseases, the 'right not to know' of the future child will become a new issue in the debate about prenatal screening. With regard to the controversial issue of selective abortion, it may make a morally relevant difference that after NIPD testing, abortion can be done early. A lower moral status may be attributed to the foetus at that moment, given the dominant opinion that the moral status of the foetus progressively increases with its development.
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Leithner K, Pörnbacher S, Assem-Hilger E, Krampl-Bettelheim E, Prayer D. Prenatal magnetic resonance imaging: towards optimized patient information. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:182-187. [PMID: 19598209 DOI: 10.1002/uog.6391] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To investigate the perception of fetal magnetic resonance imaging (MRI) by women confronted with the necessity of a targeted prenatal examination because of suspicion of an abnormality, in order to develop a pre-scan information leaflet tailored to the information requirements of these women. METHODS Sixty-two women were assessed by qualitative interview immediately before and after scanning. Data were analyzed by means of a qualitative content analysis. The transcribed interviews were coded within established categories, including knowledge of the purpose of the exam, understanding of the procedure, expectation of the baby's reaction, satisfaction with pre-information, experience of fetal MRI, distressing conditions during scanning, anxiety and suggestions for improvement of the scanning procedure. RESULTS Pre-scan interviews indicated 66% of our sample to be well-informed about the purpose of fetal MRI. A realistic, detailed description of the examination was given by 37%. Only 32% expected the scanning to be safe for their baby. Despite the overall good tolerance of fetal MRI (63%), post-scan interviews revealed that 58% of women had experienced anxiety during MRI, which was partly due to the fearful perception of intensified fetal body movements during scanning. The quality of the pre-information leaflet was rated as sufficiently informative by 68% of the women. Suggestions for improvement were centered on physical conditions, the presence of the partner during scanning, and the availability of pre-scan briefings. CONCLUSIONS Based on women's needs, detailed information about the fetal MRI procedure should be provided, containing clear-cut explanations about the purpose, course, method and possible distressing conditions. A leaflet describing these details should be given to women by the referring physician well in advance of the examination, and the woman given the opportunity to discuss unclear points.
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Affiliation(s)
- K Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria.
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30
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Favre R, Guige V, Weingertner AS, Vayssière C, Kohler M, Nisand I, Hervé C, Moutel G. Is the non-respect of ethical principles by health professionals during first-trimester sonographic Down syndrome screening damaging to patient autonomy? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:25-32. [PMID: 19489032 DOI: 10.1002/uog.6327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the understanding of health professionals involved in first-trimester ultrasound screening of the ethical stakes involved by addressing three questions regarding: how much these professionals know about Down syndrome screening by nuchal translucency thickness measurement; their personal opinion with respect to this screening test; and their attitude with respect to their patients, in order to answer the question: 'Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?' METHODS We studied the medical population in the east part of France by sending a questionnaire to each of 460 medical correspondents. This questionnaire attempted to evaluate the respondent's level of medical knowledge, their personal opinion with respect to first-trimester screening and their attitude towards their patients. We adapted the three-dimensional diagram designed by Marteau et al. to develop a measure of informed choice regarding screening. Only health professionals who were relatively well informed and adopted an autonomy-oriented approach were considered to be in a position to obtain true consent from their patients, respecting ethical principles in terms of competence and the autonomy of patients. RESULTS We received 276 (60%) responses to the questionnaire. Only 31.9% of health professionals had an approach that facilitated obtaining true consent from their patients and respected the ethical principles of competence and patient autonomy; 46% were in favor of the screening test and adopted an autonomy-oriented approach but were poorly informed; and 15.4% had a directive-authoritarian approach combined with poor knowledge. Regression analysis showed that two independent factors (speciality (P = 0.031) and location of practice (P = 0.034)) affected the level of medical knowledge, and two independent factors (location of practice (P = 0.034) and the type of medical practice i.e. public or private (P < 0.05)) affected the opinion of health professionals about the screening test. Two independent factors (speciality (P < 0.001) and the age of the health professional (P = 0.02)) affected the attitudes of health professionals towards their patients. CONCLUSION The answer to the question 'Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?' is clearly 'No'. Major effort is required to ensure that the decisions made by patients are based on a possibility of true choice.
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Affiliation(s)
- R Favre
- Centre Medical, Chirugical et Obstétrical (CMCO)-Département de Médecine Foetale, Schiltigheim, France.
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Azria E, Schmitz T, Bourgeois-Moine A, Goffinet F, Tsatsaris V, Mahieu-Caputo D. Peut-on concilier autonomie maternelle et responsabilité médicale dans les décisions de voies d’accouchement des fœtus en siège ? Rôle de l’information. ACTA ACUST UNITED AC 2009; 37:464-9. [DOI: 10.1016/j.gyobfe.2009.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
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