Benefits and harms of antenatal and newborn screening programmes in health economic assessments: the VALENTIA systematic review and qualitative investigation

Background

Health economic assessments are used to determine whether the resources needed to generate net benefit from an antenatal or newborn screening programme, driven by multiple benefits and harms, are justifiable. It is not known what benefits and harms have been adopted by economic evaluations assessing these programmes and whether they omit benefits and harms considered important to relevant stakeholders.

Objectives

(1) To identify the benefits and harms adopted by health economic assessments in this area, and to assess how they have been measured and valued; (2) to identify attributes or relevance to stakeholders that ought to be considered in future economic assessments; and (3) to make recommendations about the benefits and harms that should be considered by these studies.

Design

Mixed methods combining systematic review and qualitative work.

Systematic review methods

We searched the published and grey literature from January 2000 to January 2021 using all major electronic databases. Economic evaluations of an antenatal or newborn screening programme in one or more Organisation for Economic Co-operation and Development countries were considered eligible. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. We identified benefits and harms using an integrative descriptive analysis and constructed a thematic framework.

Qualitative methods

We conducted a meta-ethnography of the existing literature on newborn screening experiences, a secondary analysis of existing individual interviews related to antenatal or newborn screening or living with screened-for conditions, and a thematic analysis of primary data collected with stakeholders about their experiences with screening.

Results

The literature searches identified 52,244 articles and reports, and 336 unique studies were included. Thematic framework resulted in seven themes: (1) diagnosis of screened for condition, (2) life-years and health status adjustments, (3) treatment, (4) long-term costs, (5) overdiagnosis, (6) pregnancy loss and (7) spillover effects on family members. Diagnosis of screened-for condition (115, 47.5%), life-years and health status adjustments (90, 37.2%) and treatment (88, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Long-term costs, overdiagnosis and spillover effects tended to be ignored. The wide-reaching family implications of screening were considered important to stakeholders. We observed good overlap between the thematic framework and the qualitative evidence.

Limitations

Dual data extraction within the systematic literature review was not feasible due to the large number of studies included. It was difficult to recruit healthcare professionals in the stakeholder's interviews.

Conclusions

There is no consistency in the selection of benefits and harms used in health economic assessments in this area, suggesting that additional methods guidance is needed. Our proposed thematic framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programmes.

Study registration

This study is registered as PROSPERO CRD42020165236.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127489) and is published in full in Health Technology Assessment; Vol. 28, No. 25. See the NIHR Funding and Awards website for further award information.

Evaluation of Informative Content on Cerebral Palsy in the Era of Artificial Intelligence: The Value of ChatGPT

AIMS

In addition to the popular search engines on the Internet, ChatGPT may provide accurate and reliable health information. The aim of this study was to examine whether ChatGPT's responses to frequently asked questions concerning cerebral palsy (CP) by families were reliable and useful.

METHODS

Google trends were used to find the most frequently searched keywords for CP. Five independent physiatrists assessed ChatGPT responses to 10 questions. Seven-point Likert-type scales were used to rate information reliability and usefulness based on whether the answer can be validated and is understandable.

RESULTS

The median ratings for reliability of information for each question varied from 2 (very unsafe) to 5 (relatively very reliable). The median rating was 4 (reliable) for four questions. The median ratings for usefulness of information varied from 2 (very little useful) to 5 (moderately useful). The median rating was 4 (partly useful) for seven questions.

CONCLUSION

Although ChatGPT appears promising as an additional tool for informing family members of individuals with CP about medical information, it should be emphasized that both consumers and health care providers should be aware of the limitations of artificial intelligence-generated information.

Identification of maternal attitudes and knowledge about newborn screenings: a Turkey sample

This study was planned to determine maternal attitudes and knowledge about newborn screening. The universe of the descriptive study consisted of postpartum mothers living in the centers of three provinces in the north and east of Turkey. The sample included mothers who were older than 18 years of age, who could read and write Turkish, whose babies were in the 24th and 72nd hour after birth, and who volunteered to take part in the study. The study was completed with 407 mothers. The data were collected with the face-to-face interview method by the researchers using the "Descriptive Information Form" and the "Maternal Attitudes and Knowledge Survey about Newborn Screening." The results showed that 40.3% of the mothers were between the ages of 25 and 30 years, 52.8% received information about newborn screening, 61.1% received this information during pregnancy (27.3% in the first trimester and 33.8% in the last trimester), and most of the information was provided by a healthcare professional (77.8%). Mothers with only one child (p = .001) and those with nuclear families (p = .024) were found to have lower maternal attitudes and knowledge about newborn screening. The study showed that the level of knowledge of Turkish mothers about newborn screening is inadequate in general. In particular, the knowledge and attitudes of mothers with nuclear families, those with one child, and those not having regular check-ups during pregnancy are inadequate. Improving mothers' understanding of screening tests will lead to more successful screening program implementation and earlier detection and care of newborns with a disease.

Absorbing it all: A meta-ethnography of parents' unfolding experiences of newborn screening

In a context of increasing international dialogue around the appropriate means and ends of newborn screening programmes, it is critical to explore the perspectives of those directly impacted by such screening. This meta-ethnography uses a systematic review process to identify qualitative studies that focus on parents' experiences of newborn screening published in English-language academic journals from 2000 to 2019 (n = 36). The included studies represent a range of moments, outcomes, and conditions that illuminate discrete elements of the newborn screening journey. We draw on these varied studies to construct a diagram of possible newborn screening pathways and through so-doing identify a critical window of time between the signalling of a positive newborn screen and the end of the screening process. During this critical window of time, families navigate complex emotional reactions, information, and decisions. From an in-depth analysis of this data, we develop the concept of "absorptive capacity" as a lens through which to understand parents' responses to new and emerging information. Alongside this, we identify how the "concertinaing of time" - the various ways that parents experience the expansion and compression of time throughout and beyond the screening pathway - affects their absorptive capacities. This study underscores the need to move away from viewing newborn screening as a discrete series of clinical events and instead understand it as a process that can have far-reaching implications across time, space, and family groups. Using this understanding of screening as a starting point, we make recommendations to facilitate communication and support for screened families, including the antenatal provision of information to parents and accommodations for the fluctuations in parents' absorptive capacities across the screening trajectory.

Vulnerable Child Syndrome and Newborn Screening Carrier Results for Cystic Fibrosis or Sickle Cell

OBJECTIVES

To measure parental perceptions of child vulnerability, as a precursor to developing a population-scale mechanism to mitigate harm after newborn screening.

STUDY DESIGN

Participants were parents of infants aged 2-5 months. Parental perceptions of child vulnerability were assessed with an adapted version of the Vulnerable Baby Scale. The scale was included in the script for a larger study of telephone follow-up for 2 newborn blood screening samples (carrier status for cystic fibrosis or sickle cell hemoglobinopathy). A comparison sample was added using a paper survey with well-baby visits to an urban/suburban clinic.

RESULTS

Sample sizes consisted of 288 parents in the cystic fibrosis group, 426 in the sickle cell hemoglobinopathy group, and 79 in the clinic comparison group. Parental perceptions of child vulnerability were higher in the sickle cell group than cystic fibrosis group (P < .0001), and both were higher than the clinic comparison group (P < .0001). Parental perceptions of child vulnerability were inversely correlated with parental age (P < .002) and lower health literacy (P < .015, sickle cell hemoglobinopathy group only).

CONCLUSIONS

Increased parental perceptions of child vulnerability seem to be a bona fide complication of incidental newborn blood screening findings, and healthcare professionals should be alert to the possibility. From a public health perspective, we recommend routine follow-up after incidental findings to mitigate psychosocial harm.

Experience with Parent Follow-Up for Communication Outcomes after Newborn Screening Identifies Carrier Status

OBJECTIVE

To conduct interviews with a multiyear sample of parents of infants found to have heterozygous status for sickle cell hemoglobinopathy or cystic fibrosis during newborn blood screening (NBS).

STUDY DESIGN

Interviewers with clinical backgrounds telephoned parents, and followed a structured script that blended follow-up and research purposes. Recruiting followed several steps to minimize recruiting bias as much as possible for a NBS study.

RESULTS

Follow-up calls were conducted with parents of 426 infant carriers of sickle cell hemoglobinopathy, and 288 parents of cystic fibrosis carriers (34.8% and 49.6% of those eligible). Among these, 27.5% and 7.8% had no recollection of being informed of NBS results. Of those who recalled a provider explanation, 8.6% and 13.0% appraised the explanation negatively. Overall, 7.4% and 13.2% were dissatisfied with the experience of learning about the NSB result. Mean anxiety levels were low but higher in the sickle cell hemoglobinopathy group (P < .001). Misconceptions that the infant might get the disease were present in 27.5% and 7.8% of parents (despite zero actual risk for disease). Several of these data were significantly predicted by NBS result, health literacy, parental age, and race/ethnicity factors.

CONCLUSIONS

Patient-centered public health follow-up can be effective after NBS identifies carrier status. Psychosocial complications were uncommon, but harms were substantial enough to justify mitigation.

Online information use on health/illness by relatives of hospitalized premature infants

ABSTRACT Objective: To analyze the use of online information on health/illness by relatives of premature infants admitted to the Neonatal Intensive Care Unit. Method: Exploratory, qualitative study conducted at a Neonatal Intensive Care Unit from a University Hospital in the state capital of southern Brazil, with 33 relatives of hospitalized premature infants. The data were collected through a semi-structured interview and were submitted to thematic analysis, with the aid of the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ®). Results: From the data analysis, two thematic categories emerged: Online information on health/illness researched by relatives; and Online sources of information consulted by relatives. Final considerations: Health professionals need to consider the use of online information by relatives in the care process, adding it in their practice in relation to the informational needs presented, and stimulating spaces for dialogue about the data found.