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Bitar L, Chaccour C, Bitar ER, Halabi R, Kesrouani A. Parental refusal of prenatal screening for aneuploidies. J Perinat Med 2024; 52:369-374. [PMID: 38485523 DOI: 10.1515/jpm-2023-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/15/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES To analyze the reasons for refusal of aneuploidy screening in a multicultural Middle Eastern population. METHODS The study included patients delivering in a university hospital, who had refused aneuploidy screening during their pregnancy. We evaluated through a questionnaire submitted during the postpartum period the sociodemographic characteristics, beliefs, attitudes, and the main reason underpinning their choice. Religious, ethical, and financial factors, personal beliefs, medical information, perceived media information, and familial input were assessed through a Likert scale. RESULTS Our pilot study included 70 patients. The main reason (33 %) was the refusal to terminate pregnancy if the screening tests ultimately led to a diagnosis of aneuploidy. Lack of adequate information on the availability and benefits of this screening method (28 %), religious beliefs (17 %), in addition to other minor reasons such as financial considerations, familial recommendations, late pregnancy follow-ups, and media influence were also identified as contributing factors. CONCLUSIONS Aneuploidy screening is routinely offered to couples, with varying uptake rates observed worldwide. Sufficient information on prenatal screening and diagnosis should be provided to all pregnant women, presenting all available options, thus enabling them to make a free and informed choice during their pregnancy.
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Affiliation(s)
- Lynn Bitar
- Faculty of Medicine, 36925 St Joseph University , Beirut, Lebanon
| | - Christian Chaccour
- Obstetrics and-Gynecology Department, 36925 Hôtel-Dieu de France Hospital, St Joseph University , Beirut, Lebanon
| | - Elio R Bitar
- Faculty of Medicine, 11238 American University of Beirut , Beirut, Lebanon
| | - Rami Halabi
- Department of Urology, School of Medicine and Medical Sciences, 67028 Holy Spirit University of Kaslik , Jounieh, Lebanon
| | - Assaad Kesrouani
- Obstetrics and-Gynecology Department, 36925 Hôtel-Dieu de France Hospital, St Joseph University , Beirut, Lebanon
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2
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Ternby E, Axelsson O, Georgsson S, Malmgren CI. Pregnant women's informational needs prior to decisions about prenatal diagnosis for chromosomal anomalies-A Q methodological study. Prenat Diagn 2024; 44:480-491. [PMID: 38167810 DOI: 10.1002/pd.6514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To study pregnant women's subjective viewpoints on what is important when receiving information prior to decision-making regarding prenatal testing for chromosomal anomalies. METHOD Data were collected using Q methodology. During January 2020-October 2021, 45 pregnant women in Sweden completed a 50-item Q sort. Statements regarding what is important when receiving information about prenatal screening and diagnosis were prioritized through ranking in a fixed sorting grid on an 11-point scale, from "most important" to "least important." Socio-demographics and coping styles were surveyed through questionnaires. RESULTS Three groups represented different viewpoints on what pregnant women consider important when receiving information about prenatal screening and diagnosis. Factor 1: Stepwise information and decision-making: viewing information and decision-making as a step-by-step process. Factor 2: Decision-making as a continuous process based on couple autonomy: Striving for an informed decision as a couple about tests, test results and conditions screened. Factor 3: As much information as early as possible-the importance of personal autonomy in decision-making: Prioritizing autonomous decision-making based on non-directive information early in the pregnancy. CONCLUSION This study highlights the complexities involved when providing information. As shown by the differing viewpoints in this study, pregnant women's informational needs differ, making individual and personalized information preferable.
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Affiliation(s)
- Ellen Ternby
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ove Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | | | - Charlotta Ingvoldstad Malmgren
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
- Centre for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Centre for Research and Bioethics, Uppsala University, Uppsala, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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3
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Kesrouani A, Abi Antoun M, Obeid R. Parental decision-making for prenatal screening tests in a Middle-Eastern population. J Matern Fetal Neonatal Med 2023; 36:2183742. [PMID: 36889733 DOI: 10.1080/14767058.2023.2183742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Assaad Kesrouani
- Obstetrics and-Gynecology Department, St Joseph University Hotel-Dieu de France University Hospital, Beirut, Lebanon.,Obstetrics and-Gynecology Department, Bellevue Medical Center, Beirut, Lebanon
| | - Melissa Abi Antoun
- Obstetrics and-Gynecology Department, St Joseph University Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - Reem Obeid
- Obstetrics and-Gynecology Department, St Joseph University Hotel-Dieu de France University Hospital, Beirut, Lebanon
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4
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Damman OC, Henneman L, IJssel DVVD, Timmermans DRM. Conditions for autonomous reproductive decision-making in prenatal screening: A mixed methods study. Midwifery 2023; 119:103607. [PMID: 36753831 DOI: 10.1016/j.midw.2023.103607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pregnant women should be able to make autonomous and meaningful decisions about prenatal screening for fetal abnormalities. It remains largely unclear which circumstances facilitate or hinder such a decision-making process. OBJECTIVE To investigate what conditions Dutch pregnant women and professional experts consider important for autonomous reproductive decision-making in prenatal screening for fetal abnormalities, and the extent to which, according to women, those conditions are met in practice. METHODS A mixed methods study was conducted in the Netherlands in 2016-2017. A conceptual model was used to interview professional experts (n = 16) and pregnant women (n = 19). Thematic analysis was performed to identify important conditions. Subsequently, a questionnaire assessed the perceived importance of those conditions and the extent to which these were met, in the experience of pregnant women (n = 200). RESULTS Professional experts stressed the importance of information provision, and emphasized a rational decision-making model. Pregnant women differed in what information they felt was needed, and this depended on the screening decision made. Questionnaire findings showed that women prioritized discussion and consensus with partners. Information about test accuracy and miscarriage risk of invasive follow-up testing was also considered important. Two key conditions were not adequately met, in the experience of women: (1) having information about miscarriage risk; (2) not being directed by health professionals in decision-making. CONCLUSION According to women, discussion and consensus with partners was considered a highly important condition for an autonomous and meaningful decision-making process. Access to information about safety of testing and ensuring that women are not being directed in their decision-making by health professionals seem to be areas for improvement in prenatal care practice.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Section Community Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Dalisa V van den IJssel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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5
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Adams AD, Jumah N, Okun N, Bonham VL. Equitable delivery of expanded genetic technologies: Considerations for prenatal and reproductive care. Prenat Diagn 2023; 43:435-442. [PMID: 36825328 DOI: 10.1002/pd.6338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Naana Jumah
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, Ontario, Canada
| | - Nanette Okun
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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6
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Stanić Ž, Hrgović Z, Fureš R, Vusić I, Lagančić M. Ethical Aspects of Prenatal DNA Testing. Z Geburtshilfe Neonatol 2022; 226:300-303. [DOI: 10.1055/a-1904-8406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AbstractCell-free DNA (cfDNA) first-trimester screening for fetal aneuploidies, as a
non-invasive, safe, and rather accurate method, has changed prenatal screening
policies all over the world. Owing to aggressive marketing, cfDNA screening
tests exhibit global popularity and a rapid spread in routine prenatal care.
However, wide availability of the tests, together with observed difficulties in
the test’s interpretation, bring to light several serious ethical
concerns. To date it is vital to identify and address the most important
ethical, legal, and social issues regarding prenatal screening tests.
Furthermore, guidelines and restrictions in certain cfDNA screening advancements
that may provide information regarding fetal genetic traits of unknown clinical
significance, conditions with variable penetrance, or late-onset conditions,
should be considered.
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Affiliation(s)
- Žana Stanić
- Department for Integrative Gynecology, Obstetrics and Minimally
Invasive Gynecologic Surgery, Zabok General Hospital and Croatian Veterans
Hospital, Zabok, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer
University of Osijek, Osijek, Croatia
| | - Zlatko Hrgović
- Women's Health Clinic, J. W. Goethe University
Frankfurt, Frankfurt am Main, Germany
| | - Rajko Fureš
- Department for Integrative Gynecology, Obstetrics and Minimally
Invasive Gynecologic Surgery, Zabok General Hospital and Croatian Veterans
Hospital, Zabok, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer
University of Osijek, Osijek, Croatia
| | - Iva Vusić
- Health Center of Bjelovar-Bilogora County, Bjelovar,
Croatia
| | - Marko Lagančić
- Emergency Department, University Hospital Dubrava, Zagreb,
Croatia
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7
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Why do French women refuse to have Down's syndrome screening by maternal serum testing? A mixed methods study. Midwifery 2022; 110:103351. [DOI: 10.1016/j.midw.2022.103351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 02/02/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022]
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Carlsson Y, Strömbäck P, Lundgren I. Parents' experiences of the information provided at the antenatal clinic regarding foetal diagnostics - A qualitative interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100652. [PMID: 34375881 DOI: 10.1016/j.srhc.2021.100652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/02/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to examine the pregnant women's and their partner's experience of the information given at the antenatal clinic regarding screening methods. METHODS A qualitative interview study was conducted in the Gothenburg area in Sweden. Ten women and seven partners expecting their first child were interviewed adjacent to the second-trimester ultrasound examination. The data were analysed using qualitative content analysis. RESULTS The findings present an overall theme, three main categories, and ten subcategories. The overall theme showed a nonhomogeneous and individually based picture concerning the meaning and purpose of the methods, need for improvement of information, parents own information seeking, and the encounter with the midwife was also experienced as an influential encounter. The main categories show that diversity relates to the level of information given, voluntariness, the possibility of abnormal findings, and varying needs to thorough information and pre-existing knowledge. The midwifés impact was related to attitude, openness for questions, time for explanations, and the balance between providing enough information to support without worrying the parents. CONCLUSIONS Although previous research has pointed out a decade ago that information regarding foetal diagnostics is lacking, this study shows that these shortcomings still exist and that improvement is needed. The given information should be explicit concerning the purpose, limitations, and voluntariness of prenatal testing. Sufficient time for questions and discussion is as important as considering the parents' pre-existing knowledge, individual thoughts or questions, and a neutral attitude from the midwife is desirable.
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Affiliation(s)
- Ylva Carlsson
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, 405 83 Gothenburg, Sweden; Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden.
| | - Pernilla Strömbäck
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, 405 83 Gothenburg, Sweden
| | - Ingela Lundgren
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, 405 83 Gothenburg, Sweden; Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden.
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9
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Pop-Tudose ME, Armean P, Pop IV. Prenatal screening for Down syndrome: popularity, perceptions and factors associated with acceptance or refusal of testing. J Matern Fetal Neonatal Med 2021; 35:6505-6509. [PMID: 33910457 DOI: 10.1080/14767058.2021.1916910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prenatal screening tests for aneuploidies have become increasingly used in maternal and fetal medicine. Given that all pregnancies associate a potential risk of Down syndrome, adequate knowledge of the tests, and their characteristics as well as facilitating decision-making autonomy are fundamental rights that must be respected. OBJECTIVES Identification of the popularity of the tests, their perception and the factors associated with the acceptance or refusal to perform them. METHODS A cross-sectional study was carried out in the South-East region of Romania, between April and September 2016. The data were collected from 275 postpartum women. The instrument used was a self-administered questionnaire and the data obtained were processed using the IBM SPSS 20.0 statistical software (IBM Corp., Armonk, NY, USA). The normality of the distribution was analyzed with Chi-square, Kolmogorov-Smirnov and Shapiro-Wilk tests. Factorial Analysis was carried out for the Principal Components of the scales for the reasons for performing and not performing. RESULTS The 2nd Trimester Morphology had the popularity as well as the highest rate of accomplishment (98.2% respectively 67.6%) among the investigated women. It is also the preferred recommendation of the specialists (81.1%). The least popular test was the TPNI, only 13.1% of the participants heard about it, as it was recommended in only 2% of the situations. Most of the participants perceived the screening tests as essential and useful, but 43.3% considered that they become mandatory if the doctor recommends them. The acceptance of the child with DS and the misperception of the risk were the main factors associated with the refusal of the test and the compliance with the recommendation of the specialist (system confidence), and social influence (non-acceptance of the Down syndrome by the society) were the main factors associated with the acceptance. CONCLUSIONS The number of women who made the decision to accept the test was greater than the ones who refused. The amendment is that acceptance was based on the custom of socio-economic-medical compliance and responsibility. For many women, the motivation of acceptance meant alignment with the normality directed by the society and the system. Even the popularity of the tests carries the imprint of the beliefs and values of the system and the specialists involved. For an adequate perception and an autonomous and informed choice of women, the screening program must include adequate information and communication services by involving specialists responsible for multidisciplinary competencies. The percentage of completion and the type of test performed almost perfectly align with the recommendations received.
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Affiliation(s)
- Melania Elena Pop-Tudose
- Department of Genetics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Petru Armean
- Specific Disciplines, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Victor Pop
- Department of Genetics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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10
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Ogamba CF, Roberts AA, Babah OA, Ikwuegbuenyi CA, Ologunja OJ, Amodeni OK. Correlates of knowledge of genetic diseases and congenital anomalies among pregnant women attending antenatal clinics in Lagos, South-West Nigeria. Pan Afr Med J 2021; 38:310. [PMID: 34178228 PMCID: PMC8197039 DOI: 10.11604/pamj.2021.38.310.26636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction genetic diseases and congenital anomalies place a significant burden on the health of new-borns and their mothers. Despite the availability of a variety of prenatal screening tests, mothers' knowledge has been documented to determine uptake. This study aims to assess the knowledge of pregnant women about birth defects and the associated correlates with regard to willingness to do prenatal screening. Methods a cross-sectional descriptive study was conducted among 422 antenatal mothers recruited sequentially as they attended antenatal clinics at the Lagos University Teaching Hospital. An interviewer-administered questionnaire was used to determine their knowledge of birth defects and willingness to do prenatal testing. Results majority of the participants (92.2%) had at least secondary education. The mean total knowledge score of the respondents was 63%. Age and knowledge scores were not significantly correlated (r=-0.071, p=0.14). Being employed predicted higher knowledge scores (95% CI: 0.09, 2.09, p=0.03). Respondents who had primary school education and those who replied “I don't know” to willingness to test had significantly lower knowledge scores (95% CI: -15.01, -1.19, p=0.02 and 95% CI: -4.52, -0.68, p=0.01 respectively). Majority (79.1%) of the respondents were willing to undergo testing. Respondents' level of education was significantly associated with willingness to test (p=0.03). Conclusion the observed knowledge gaps were considerable. There is need for improvement in education, the empowerment of women and access to quality healthcare including prenatal screening.
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Affiliation(s)
| | - Alero Ann Roberts
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ochuwa Adiketu Babah
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
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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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12
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Bunnik EM, Kater-Kuipers A, Galjaard RJH, de Beaufort ID. Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access. JOURNAL OF MEDICAL ETHICS 2020; 46:194-198. [PMID: 31527142 PMCID: PMC7042959 DOI: 10.1136/medethics-2019-105675] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 05/28/2023]
Abstract
The introduction of non-invasive prenatal testing (NIPT) in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to (co)pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: (1) to prevent increased uptake of NIPT and (2) to promote informed choice. First, given the aim of prenatal screening (reproductive autonomy), high or low uptake rates are not intrinsically desirable or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women's choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external (ie, financial) influences on women's personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring (substantial) copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair.
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Affiliation(s)
- Eline M Bunnik
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Adriana Kater-Kuipers
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inez D de Beaufort
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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13
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Sahin E, İnciser Paşalak Ş, Seven M. Consanguineous marriage and its effect on reproductive behavior and uptake of prenatal screening. J Genet Couns 2020; 29:849-856. [PMID: 31919935 DOI: 10.1002/jgc4.1214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/02/2019] [Accepted: 12/18/2019] [Indexed: 11/11/2022]
Abstract
The study aimed to determine the prevalence of consanguinity among pregnant women, its effect on reproductive behavior and the uptake of prenatal screening. The sample consisted of 842 pregnant women recruited to a prospective cohort study conducted in twenty-three cities from different regions in Turkey between June 2017 and March 2018. Of the women, 17.7% (n = 149) were in consanguineous marriages. The consanguineous couples were younger at the time of their marriages than non-consanguineous couples, and 49% of the consanguineous marriages were arranged. The educational levels of both spouses in consanguineous marriages were lower than those in non-consanguineous marriages. There was a statistically significant difference in the prevalence of the pregnant women having a prenatal screening test between women in consanguineous marriages (53%) and those in non-consanguineous marriages (78.2%). There were no statistically significant differences between the two groups in terms of having health problems during pregnancy, the number of pregnancies, abortions and/or stillbirths, the week of delivery and the birthweight of the baby. Healthcare providers play a key role in eliciting whether or not pregnant couples are consanguineous, providing a tailored risk assessment, education, and counseling about screening and diagnostic tests for early diagnosis and management of the fetus, explaining the testing process and possible outcomes, and helping couples make informed decisions regarding their reproductive options or pregnancy management.
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Affiliation(s)
- Eda Sahin
- Health Science Faculty, Giresun University, Giresun, Turkey
| | | | - Memnun Seven
- School of Nursing, Koç University, İstanbul, Turkey.,College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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14
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Peters IA, Heetkamp KM, Ursem NTC, Steegers EAP, Denktaş S, Knapen MFCM. Ethnicity and Language Proficiency Differences in the Provision of and Intention to Use Prenatal Screening for Down's Syndrome and Congenital Anomalies. A Prospective, Non-selected, Register-Based Study in the Netherlands. Matern Child Health J 2019; 22:343-354. [PMID: 28884405 PMCID: PMC5845051 DOI: 10.1007/s10995-017-2364-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective We aimed to conduct an analysis of the associations between the information provision procedure of prenatal screening for Down's syndrome and congenital anomalies and the intention to participate in prenatal screening (PS) of ethnicity groups and Dutch language proficiency groups. Design Using a prospective web-based registration form, we asked counselors (midwives, general practitioners, nurses and gynecologists) to report whether and how they offered information about PS to pregnant women. Duration The study was conducted from 2008 to 2010. Participants We collected data on the characteristics of the women who received an information offer about PS from counselors. Measurements Measures included socio-demographic and language proficiency level (LPL) characteristics, key elements of the provision procedure of PS, and intentional participation in PS. Findings The dataset represents 37% of the total population in the study area. Women with a non-native Dutch background and/or insufficient Dutch LPL received fewer information offers about PS, faced a reduced chance of receiving counseling, and showed lower intentional participation rates for PS. Key Conclusions Women with a non-native Dutch background and/or with an insufficient LPL are underserved in the Dutch PS program. These findings present evidence indicating that the fundamental principle of the Dutch Population Screening Act, namely, equal access to PS for all pregnant women, is not being realized. Implications for Practice Therefore, the study findings are important for national and international healthcare, policy makers and governmental professionals to allow ethnic and LPL-related differences in the provision and intentional uptake of PS.
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Affiliation(s)
- Ingrid A Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands. .,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands.
| | - Kirsten M Heetkamp
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - Nicolette T C Ursem
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands
| | - Semiha Denktaş
- Department Social and Behavioural Sciences, EUC/Erasmus University Rotterdam, Nieuwemarkt 1a, 3011 HP, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands
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15
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Netshisaulu KG, Maputle MS. Expected clinical competence from midwifery graduates during community service placement in Limpopo province, South Africa. Health SA 2018; 23:1166. [PMID: 31934392 PMCID: PMC6917449 DOI: 10.4102/hsag.v23i0.1166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/22/2018] [Indexed: 11/11/2022] Open
Abstract
Background Community service nurses are placed in a hospital within the first year after qualifying to obtain clinical experience under the supervision of experienced professional nurses. When placed in clinical environments, new midwifery graduates are expected to be job ready, demonstrate competence in the provision of evidence-based care, practise independently and assume accountability and responsibility for their own actions. Aim The study aimed at exploring the expectations of experienced midwives of clinical competence of newly graduated midwives during transition. Setting The study was conducted at the training hospitals of the five districts in Limpopo province. Method The researcher used a qualitative approach which is explorative and descriptive in nature. The population comprised all the professional midwives with experience of 5 years and above working at the selected hospitals in Vhembe, Mopani, Capricorn, Waterberg and Sekhukhune districts of Limpopo province, South Africa. From each selected hospital, five experienced midwives were selected using non-probability, purposive sampling method. An in-depth individual face-to-face interview was used to collect data from the participants, until saturation was reached. The open-coding, Tesch’s eight-step process was used to analyse data. Results Results revealed that newly graduated midwives failed to meet the perceived expectations by experienced midwives; this was reflected in sub-themes: limited sense of independence, limited participation in task sharing and commitment and competence versus incompetence to patient care. Conclusion The experienced midwives expected newly graduated midwives to function as professionals; unfortunately, they expressed disappointment as graduates did not meet their expectations. Newly graduated midwives lacked sense of independence, commitment to patient care and did not display ability in task sharing.
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Affiliation(s)
| | - Maria S Maputle
- Department of Advanced Nursing Science, University of Venda, South Africa
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16
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Kater-Kuipers A, Bunnik EM, de Beaufort ID, Galjaard RJH. Limits to the scope of non-invasive prenatal testing (NIPT): an analysis of the international ethical framework for prenatal screening and an interview study with Dutch professionals. BMC Pregnancy Childbirth 2018; 18:409. [PMID: 30340550 PMCID: PMC6194707 DOI: 10.1186/s12884-018-2050-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background The introduction of non-invasive prenatal testing (NIPT) for foetal aneuploidies is currently changing the field of prenatal screening in many countries. As it is non-invasive, safe and accurate, this technique allows for a broad implementation of first-trimester prenatal screening, which raises ethical issues, related, for instance, to informed choice and adverse societal consequences. This article offers an account of a leading international ethical framework for prenatal screening, examines how this framework is used by professionals working in the field of NIPT, and presents ethical guidance for the expansion of the scope of prenatal screening in practice. Methods A comparative analysis of authoritative documents is combined with 15 semi-structured interviews with professionals in the field of prenatal screening in the Netherlands. Data were recorded, transcribed verbatim and analysed using thematic analysis. Results The current ethical framework consists of four pillars: the aim of screening, the proportionality of the test, justice, and societal aspects. Respondents recognised and supported this framework in practice, but expressed some concerns. Professionals felt that pregnant women do not always make informed choices, while this is seen as central to reproductive autonomy (the aim of screening), and that pre-test counselling practices stand in need of improvement. Respondents believed that the benefits of NIPT, and of an expansion of its scope, outweigh the harms (proportionality), which are thought to be acceptable. They felt that the out-of-pocket financial contribution currently required by pregnant women constitutes a barrier to access to NIPT, which disproportionally affects those of a lower socioeconomic status (justice). Finally, professionals recognised but did not share concerns about a rising pressure to test or discrimination of disabled persons (societal aspects). Conclusions Four types of limits to the scope of NIPT are proposed: NIPT should generate only test outcomes that are relevant to reproductive decision-making, informed choice should be (made) possible through adequate pre-test counselling, the rights of future children should be respected, and equal access should be guaranteed. Although the focus of the interview study is on the Dutch healthcare setting, insights and conclusions can be applied internationally and to other healthcare systems.
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Affiliation(s)
- A Kater-Kuipers
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Room 24.17, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - E M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Room 24.17, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - I D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Room 24.17, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - R J H Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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17
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Kostenko E, Chantraine F, Vandeweyer K, Schmid M, Lefevre A, Hertz D, Zelle L, Bartha JL, Di Renzo GC. Clinical and Economic Impact of Adopting Noninvasive Prenatal Testing as a Primary Screening Method for Fetal Aneuploidies in the General Pregnancy Population. Fetal Diagn Ther 2018; 45:413-423. [PMID: 30130800 DOI: 10.1159/000491750] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the clinical and economic impact of adopting noninvasive prenatal testing (NIPT) using circulating cell-free DNA as a first-line screening method for trisomy 21, 18, and 13 in the general pregnancy population. METHODS A decision-analytical model was developed to assess the impact of adopting NIPT as a primary screening test compared to conventional screening methods. The model takes the Belgium perspective and includes only the direct medical cost of screening, diagnosis, and procedure-related complications. NIPT costs are EUR 260. Clinical outcomes and the cost per trisomy detected were assessed. Sensitivity analysis measured the impact of NIPT false-positive rate (FPR) on modelled results. RESULTS The cost per trisomy detected was EUR 63,016 for conventional screening versus EUR 66,633 for NIPT, with a difference of EUR 3,617. NIPT reduced unnecessary invasive tests by 94.8%, decreased procedure-related miscarriages by 90.8%, and increased trisomies detected by 29.1%. Increasing the FPR of NIPT (from < 0.01 to 1.0%) increased the average number of invasive procedures required to diagnose a trisomy from 2.2 to 4.5, respectively. CONCLUSION NIPT first-line screening at a reasonable cost is cost-effective and provides better clinical outcomes. However, modelled results are dependent on the adoption of an NIPT with a low FPR.
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Affiliation(s)
| | | | | | | | - Alex Lefevre
- Roche Sequencing Solutions, Inc., Vilvoorde, Belgium
| | | | | | | | - Gian Carlo Di Renzo
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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18
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Karami F, Noori-Daloii MR, Omidfar K, Tabrizi M, Hantooshzadeh S, Aleyasin A, Daneshpour M, Modarressi MH. Modified methylated DNA immunoprecipitation protocol for noninvasive prenatal diagnosis of Down syndrome. J Obstet Gynaecol Res 2018; 44:608-613. [PMID: 29377389 DOI: 10.1111/jog.13577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
Abstract
AIM Methylated DNA immunoprecipitation real-time quantitative polymerase chain reaction (MeDIP-real-time qPCR) has been introduced as noninvasive prenatal test that has shown absolute detection rate in the screening of Down syndrome. Herein, we aimed to propose a novel modification of MeDIP-qPCR and assess its potential to alleviate the overall cost of the test, being used in very early weeks of pregnancy, and develop it to a noninvasive prenatal diagnosis biosensor in future researches. METHODS Cell-free fetal DNA (cffDNA) isolated from 60 pregnant women, including 29 normal and 31 trisomy 21 pregnancies, were analyzed using proposed MeDIP protocol. Enriched methylated DNA sequences were amplified through real-time qPCR using eight fetal-specific primer pairs. The status of samples was determined through the calculation of D-value with the cutoff point of zero. RESULTS The sensitivity and specificity of the MeDIP protocols using nanoparticles were 100% and 100%, respectively. CONCLUSION Remarkable decrease in the price of MeDIP test per each patient would be a reasonable factor to confirm it on larger sample size. Moreover, the high detection rate of screening and the availability of the required instruments around the world make satisfactory reasons to be tested in earlier weeks of pregnancy, thanks to the high sensitivity of gold shell nanoparticles.
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Affiliation(s)
- Fatemeh Karami
- Department of Medical Genetics, Biophotonics Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad R Noori-Daloii
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kobra Omidfar
- Biosensor Research Center, Endocrinology and Metabolite Molecular Cellular Science Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Biosensor Research Center, Endocrinology and Metabolite Molecular Cellular Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Tabrizi
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seddigheh Hantooshzadeh
- Faculty of Medicine, Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Aleyasin
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpour
- Biosensor Research Center, Endocrinology and Metabolite Molecular Cellular Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Modarressi
- Department of Medical Genetics, Biophotonics Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran.,Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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19
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Moses RM, Brown JH, Wright DC, Diplock H, Melov SJ, McGee TM. Who is and isn't having babies with Down syndrome in western Sydney: a ten year hospital cohort study. Aust N Z J Obstet Gynaecol 2017; 57:146-151. [DOI: 10.1111/ajo.12617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/22/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Rebecca M. Moses
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - James H.W. Brown
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - Dale C. Wright
- Department of Cytogenetics, Sydney Genome Diagnostics; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Hayley Diplock
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - Sarah J. Melov
- Department of Obstetrics and Gynaecology, Westmead Institute for Maternal and Fetal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Therese Mary McGee
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
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20
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A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England. J Pregnancy 2017; 2017:4975091. [PMID: 28421145 PMCID: PMC5380857 DOI: 10.1155/2017/4975091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022] Open
Abstract
Objective. The aim of this research was to explore the influence of service organisation and delivery on providers and users' interactions and decision-making in the context of Down's syndrome screening. Methods. A qualitative descriptive study involving online interviews conducted with a purposive sample of 34 community midwives, 35 pregnant women, and 15 partners from two maternity services in different health districts in England. Data were analysed using a combination of grounded theory principles and content analysis and a framework was developed. Results. The main emerging concepts were organisational constraints, power, routinisation, and tensions. Providers were concerned about being time-limited that encouraged routine, minimal information-giving and lacked skills to check users' understanding. Users reported their participation was influenced by providers' attitudes, the ambience of the environment, asymmetric power relations, and the offer and perception of screening as a routine test. Discordance between the national programme's policy of nondirective informed choice and providers' actions of recommending and arranging screening appointments was unexpected. Additionally, providers and users differing perceptions of emotional effects of information, beliefs, and expectations created tensions within them, between them, and in the antenatal environment. Conclusions. A move towards a social model of care may be beneficial to empower service users and create less tension for providers and users.
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21
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Seven M, Akyüz A, Eroglu K, Daack-Hirsch S, Skirton H. Women's knowledge and use of prenatal screening tests. J Clin Nurs 2017; 26:1869-1877. [PMID: 27487389 DOI: 10.1111/jocn.13494] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 01/16/2023]
Abstract
AIMS AND OBJECTIVES The aim of the study was to determine the rate of use of prenatal screening tests and the factors affecting the decision to have a prenatal screening test in pregnant women in Turkey. BACKGROUND Prenatal genetic screening as an optional service is commonly used to determine a level of risk for genetic conditions in the foetus. DESIGN A quantitative cross-sectional survey. METHODS Pregnant women (n = 274) who sought prenatal care from one hospital in Turkey were recruited and asked to complete questionnaires that were developed by the researchers. Descriptive and inferential statistics were used to analyse the data. RESULTS Almost half (44·2) % of the women were primiparas, and the majority (97·8%) were in the third trimester of pregnancy. Only 36·1% of the women reported that they had prenatal screening by either the double test or triple test. Women had a low level of knowledge regarding prenatal screening: the mean knowledge score was 3·43 ± 3·21 of a possible score of 10. Having consanguineous marriage, a history of spontaneous abortion, a child with genetic disorder, multiparity or a longer marriage duration were positively correlated with accepting a prenatal screening test. CONCLUSIONS This study has provided baseline data on the uptake and reasons for accepting or declining a prenatal screening in a cohort of Turkish women. There is evidence to suggest that more education is needed to improve knowledge and provide comprehensive nursing care to promote informed consent in this context. RELEVANCE TO CLINICAL PRACTICE Perinatal nurses are ideally situated to inform pregnant women about prenatal screening tests to improve access to healthcare services and to ensure informed decisions are made by pregnant women and their partners.
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Affiliation(s)
- Memnun Seven
- School of Nursing, Koç University, İstanbul, Turkey
| | - Aygül Akyüz
- School of Nursing, Koç University, İstanbul, Turkey
| | | | | | - Heather Skirton
- Professor of Applied Health Genetics, Plymouth University, Plymouth, UK
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22
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Systematic Review of the Prevalence and Incidence of Intellectual Disabilities: Current Trends and Issues. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0085-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Crombag NMTH, Schielen PCJI, Hukkelhoven CW, Iedema R, Bensing JM, Visser GHA, Stoutenbeek P, Koster MPH. Determinants of first trimester combined test participation within the central region of the Netherlands. Prenat Diagn 2016; 35:486-92. [PMID: 25613681 DOI: 10.1002/pd.4564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our objective is to study the association between potentially influential determinants and first-trimester combined test (FCT) uptake rates in the central region of the Netherlands. METHODS Data were extracted from the national prenatal screening database Peridos and the Netherlands Perinatal Registry and compared at the level of the health care provider. Univariable and multivariable linear regression analysis was used to determine the effect of determinants (maternal age, parity, socio-economic status (SES), mode of conception, ethnicity and urbanisation) on uptake. RESULTS Prenatal screening data were available for 24 657 women and overall uptake rate was 25.7%. The strongest association with FCT uptake was found for advanced maternal age (β 2.2; 95% CI [1.7, 2.8]). Grand multiparity had a significantly negative association with FCT uptake (β -4.3; 95% CI [-5.9, -2.7]). Positive associations were found for very high urbanisation (β 0.3; 95% CI [0.1, 0.4]) and high SES (β 0.2; 95% CI [0.0, 0.3]). CONCLUSION Advanced maternal age is strongly associated with participation in prenatal testing. The role of age related risk perception should be incorporated in future policy making to support women in informed and autonomous decision making. The negative association of grand multiparity and FCT might be religion based but requires further research. © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
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24
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Li C, Shi L, Huang J, Qian X, Chen Y. Factors associated with utilization of maternal serum screening for Down syndrome in mainland China: a cross-sectional study. BMC Health Serv Res 2016; 16:8. [PMID: 26762138 PMCID: PMC4712508 DOI: 10.1186/s12913-016-1260-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/07/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Knowledge of the factors that influence maternal serum screening (MSS) service utilization can be used to develop health policies to promote equitable access to MSS and further diagnostic tests. The purpose of this study was to find the factors associated with utilization of MSS as well as the current status of service utilization in mainland China. METHODS This was a hospital-based cross-sectional study with respondents interviewed with a questionnaire designed based on Andersen's behavioral model. Descriptive statistics, univariate analysis, and multilevel logistic regression analysis were used to identify the factors associated with MSS utilization, and to explore potential methods to improve screening uptake. RESULTS A total of 8110 women who had given birth within the previous 7 days in one of 111 participating institutions from six provinces in mainland China were interviewed. Approximately 36% of the participants had used MSS. Women between 20 and 35 years, who resided in urban areas, were educated, were in a stable occupation, who had health knowledge, who attended maternal preparation classes, who had received eight or more prenatal checkups, who were from a region of higher social economic status, and who delivered in a tertiary healthcare institution were significantly more likely to use MSS than their counterparts. As compared with other factors, insufficient education is the single most important demographic factor for service underutilization. CONCLUSIONS Efforts should not only be made to target the population that underuses MSS, but the overall organization of MSS service delivery should be assessed during policy development to make access to MSS equitable to the entire population of mainland China.
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Affiliation(s)
- Chuanlin Li
- School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC.
| | - Leiyu Shi
- Primary Care Policy Center, Johns Hopkins, Baltimore, MD, 21205, USA.
| | - Jiayan Huang
- School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC.
| | - Xu Qian
- School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC.
| | - Yingyao Chen
- School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC.
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25
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Gitsels-van der Wal JT, Martin L, Manniën J, Verhoeven P, Hutton EK, Reinders HS. A qualitative study on how Muslim women of Moroccan descent approach antenatal anomaly screening. Midwifery 2015; 31:e43-9. [DOI: 10.1016/j.midw.2014.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/20/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022]
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26
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Lewis C, Choudhury M, Chitty LS. ‘Hope for safe prenatal gene tests’. A content analysis of how the UK press media are reporting advances in non-invasive prenatal testing. Prenat Diagn 2014; 35:420-7. [DOI: 10.1002/pd.4488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Celine Lewis
- Clinical and Molecular Genetics; UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Mahrufa Choudhury
- Clinical and Molecular Genetics; UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Lyn S. Chitty
- Clinical and Molecular Genetics; UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
- Fetal Medicine Unit; University College London Hospitals NHS Foundation Trust; London UK
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27
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Vassy C, Rosman S, Rousseau B. From policy making to service use. Down's syndrome antenatal screening in England, France and the Netherlands. Soc Sci Med 2014; 106:67-74. [DOI: 10.1016/j.socscimed.2014.01.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
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