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Wright SJ, Vass CM, Ulph F, Payne K. Understanding the Impact of Different Modes of Information Provision on Preferences for a Newborn Bloodspot Screening Program in the United Kingdom. MDM Policy Pract 2024; 9:23814683241232935. [PMID: 38445047 PMCID: PMC10913504 DOI: 10.1177/23814683241232935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction. This study aimed to understand the impact of alternative modes of information provision on the stated preferences of a sample of the public for attributes of newborn bloodspot screening (NBS) in the United Kingdom. Methods. An online discrete choice experiment survey was designed using 4 attributes to describe NBS (effect of treatment on the condition, time to receive results, whether the bloodspot is stored, false-positive rate). Survey respondents were randomized to 1 of 2 survey versions presenting the background training materials using text from a leaflet (leaflet version) or an animation (animation version). Heteroskedastic conditional logistic regression was used to estimate the effect of mode of information provision on error variance. Results. The survey was completed by 1,000 respondents (leaflet = 525; animation = 475). Preferences for the attributes in the DCE were the same in both groups, but the group receiving the animation version had 9% less error variance in their responses. Respondents completing the animation version gave higher ratings compared with the leaflet version in terms of ease of perceived understanding. Subgroup analysis suggested that the animation was particularly effective at reducing error variance for women (20%), people with previous children (16.5%), and people between the ages of 35 and 45 y (11.8%). Limitations. This study used simple DCE with 4 attributes, and the results may vary for more complex choice questions. Conclusion. This study provides evidence that that supplementing the information package offered to parents choosing to take part in NBS with an animation may aid them their decision making. Further research would be needed to test the animation in the health system. Implications. Researchers designing DCE should carefully consider the design of their training materials to improve the quality of data collected. Highlights Prior to completing a discrete choice experiment about newborn bloodspot screening, respondents were shown information using either a leaflet-based or animated format.Respondents receiving information using an animation version reported that the information was slightly easier to understand and exhibited 9% less error variance in expressing their preferences for a newborn screening program.Using the animation version to present information appeared to have a larger impact in reducing the error variance of responses for specific respondents including women, individuals with children, individuals between the ages of 35 and 45 y, and individuals educated to degree level.
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Affiliation(s)
- Stuart J. Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, The University of Manchester, Manchester, UK
| | - Caroline M. Vass
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, The University of Manchester, Manchester, UK
- RTI Health Solutions, The Pavilion, Towers Business Park, Didsbury, Manchester, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, The University of Manchester, Manchester, UK
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Bani M, Russo S, Raggi E, Gasperini S, Motta S, Menni F, Furlan F, Cefalo G, Paci S, Banderali G, Marchisio P, Biondi A, Strepparava MG. Parents' experience of the communication process of positivity at newborn screening for metabolic diseases: A qualitative study. Child Care Health Dev 2023; 49:961-971. [PMID: 36787987 DOI: 10.1111/cch.13105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The process of receiving a communication of positivity for metabolic diseases at expanded newborn screening (ENBS) is extremely articulated, involves a variety of actors (parents, maternal and child departments, clinical centres and laboratories) and is open to a variety of outcomes from false positive to true positive cases. Receiving communication of positivity can be highly stressful for parents and requires an adequate communication process to give clear and reliable information without causing excessive worry. This qualitative study describes the parents' experience of receiving a communication of positivity to metabolic diseases at ENBS, and their assessment of the quality of the communication process and steps, with the main aim to identify the process' strengths and weaknesses and to advance tailored recommendations to improve the communication process. METHOD Fourteen in-depth, semi-structured phone interviews were conducted with parents whose children resulted positive to the ENBS. As part of the ENBS communication process, parents received a first phone call communication of positivity and a second in-person communication at metabolic clinical centres (MCC). The framework analysis method was used to organize the data and identify emerging themes. RESULTS Parents were largely dissatisfied with the quality and depth of the information received and with the way the healthcare staff delivered the first communication phone call, which failed to create a caring, empathic and safe setting. Many parents tried to reduce the uncertainty by searching online information or consulting with other providers. Nevertheless, the majority of parents described the in-person visit at MCC as clear, welcoming and reassuring. CONCLUSION More efforts are needed to improve the quality of the communication process of the ENBS. Guidelines, recommendations and standard scripts to communicate positivity are needed along with programmes and educational resources to train tailored communication skills.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Erika Raggi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Serena Gasperini
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Francesca Menni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Metabolic Reference Center, Milan, Italy
| | - Francesca Furlan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Metabolic Reference Center, Milan, Italy
| | - Graziella Cefalo
- Pediatric Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Sabrina Paci
- Pediatric Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giuseppe Banderali
- Pediatric Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Metabolic Reference Center, Milan, Italy
| | - Andrea Biondi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Clinical Psychology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Odenwald B, Brockow I, Hanauer M, Lüders A, Nennstiel U. Is Our Newborn Screening Working Well? A Literature Review of Quality Requirements for Newborn Blood Spot Screening (NBS) Infrastructure and Procedures. Int J Neonatal Screen 2023; 9:35. [PMID: 37489488 PMCID: PMC10366861 DOI: 10.3390/ijns9030035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
Newborn screening using dried blood spots (NBS) is widely acknowledged as a highly successful procedure in secondary prevention. For a number of congenital disorders, severe disability or death are impressively prevented by early detection and early treatment through NBS. However, as with any other screening, NBS can also cause harm, and the principle that "the overall benefits of screening should outweigh the harms" must be considered when introducing and implementing NBS programmes. This publication compiles the results of a systematic literature research on requirements for NBS infrastructure and procedures which was conducted as part of a research project on the quality and shortcomings of the NBS pathway in Germany. The compilation contains the requirements and recommendations for realising the principle of "maximise benefits and minimise harms" in relevant NBS pathway components such as parental education and information, coverage, timeliness, laboratory quality assurance, follow-up of abnormal results, confirmatory diagnostics, documentation, and evaluation. The results reflect the complexity of NBS infrastructure, and thus, they illustrate the importance of considering and implementing NBS as a well-coordinated public health programme with continuous quality management. Special attention should be paid to the perspectives of parents and families. Some NBS issues can substantially benefit from digital instruments or international cooperation. The literature review presented here has contributed to a concept of proposals for the advancement of NBS in Germany, and despite different settings, it may as well be of interest for other countries to achieve the best possible course and outcome of NBS for each child.
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Affiliation(s)
- Birgit Odenwald
- Newborn Screening Centre/State Institute of Health, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany
| | | | | | | | - Uta Nennstiel
- Newborn Screening Centre/State Institute of Health, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany
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Pinel J, Bellanger A, Jamet C, Moreau C. Information and Parental Consent for French Neonatal Screening: A Qualitative Study on Parental Opinion. Int J Neonatal Screen 2023; 9:ijns9020026. [PMID: 37218891 DOI: 10.3390/ijns9020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Neonatal screening has excellent coverage in France. Data from the foreign literature raise questions about the informed consent to this screening. The Neonatal Screening and Informed Consent Dépistage Néonatal Information et Consentement Eclairé (DENICE) study was designed to assess whether information on neonatal screening provided for families in Brittany allows for informed consent. A qualitative methodology was chosen to collect parents' opinions on this topic. Twenty semi-structured interviews were conducted with twenty-seven parents whose children had positive neonatal screening for one of six diseases. The five main themes from the qualitative analysis were knowledge of neonatal screening, information received by parents, parental choice, the experience of the screening process, and parents' perspectives and wishes. Informed consent was weakened by parents' lack of knowledge regarding choice and the absence of a parent after birth. The study found that more information about screening during pregnancy would be preferable. The information should be repeated and accessible and should make it clear that neonatal screening is not mandatory, but informed consent should be obtained from parents who choose to screen their newborns.
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Affiliation(s)
- Julia Pinel
- Departement of Paediatrics, Rennes University Hospital, 35000 Rennes, France
| | - Amandine Bellanger
- Department of Neonatal Special Care, Rennes University Hospital, 35000 Rennes, France
| | - Carole Jamet
- Department of General Practice, Rennes University Hospital, 35000 Rennes, France
| | - Caroline Moreau
- Biochemistry and Toxicology Laboratory, Rennes University Hospital, 35000 Rennes, France
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Ulph F, Bennett R. Psychological and Ethical Challenges of Introducing Whole Genome Sequencing into Routine Newborn Screening: Lessons Learned from Existing Newborn Screening. New Bioeth 2023; 29:52-74. [PMID: 36181705 DOI: 10.1080/20502877.2022.2124582] [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: 03/06/2023]
Abstract
As a psychologist and an ethicist, we have explored empirically newborn screening consent and communication processes. In this paper we consider the impact on families if newborn screening uses whole genome sequencing. We frame this within the World Health Organization's definition of health and contend that proposals to use whole genome sequencing in newborn screening take into account the ethical, practical and psychological impact of such screening. We argue that the important psychological processes occurring in the neonatal phase necessitate a clear justification that providing risk information at this stage provides a health benefit. We illustrate how research on current newborn screening can inform whole genome sequencing debates, whilst highlighting important gaps. Obtaining explicit, voluntary, and sufficiently informed consent for newborn screening is challenging, however we stress that such consent is ethically and legally appropriate and psychologically and practically important. We conclude by outling how this might be done.
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Affiliation(s)
- Fiona Ulph
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Bennett
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester, UK
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Wright SJ, Eden M, Ruane H, Byers H, Evans DG, Harvie M, Howell SJ, Howell A, French D, Payne K. Estimating the Cost of 3 Risk Prediction Strategies for Potential Use in the United Kingdom National Breast Screening Program. MDM Policy Pract 2023; 8:23814683231171363. [PMID: 37152662 PMCID: PMC10161319 DOI: 10.1177/23814683231171363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Economic evaluations have suggested that risk-stratified breast cancer screening may be cost-effective but have used assumptions to estimate the cost of risk prediction. The aim of this study was to identify and quantify the resource use and associated costs required to introduce a breast cancer risk-stratification approach into the English national breast screening program. Methods A micro-costing study, conducted alongside a cohort-based prospective trial (BC-PREDICT), identified the resource use and cost per individual (£; 2021 price year) of providing a risk-stratification strategy at a woman's first mammography. Costs were calculated for 3 risk-stratification approaches: Tyrer-Cuzick survey, Tyrer-Cuzick with Volpara breast-density measurement, and Tyrer-Cuzick with Volpara breast-density measurement and testing for 142 single nucleotide polymorphisms (SNP). Costs were determined for the intervention as implemented in the trial and in the health service. Results The cost of providing the risk-stratification strategy was calculated to be £16.45 for the Tyrer-Cuzick survey approach, £21.82 for the Tyrer-Cuzick with Volpara breast-density measurement, and £102.22 for the Tyrer-Cuzick with Volpara breast-density measurement and SNP testing. Limitations This study did not use formal expert elicitation methods to synthesize estimates. Conclusion The costs of risk prediction using a survey and breast density measurement were low, but adding SNP testing substantially increases costs. Implementation issues present in the trial may also significantly increase the cost of risk prediction. Implications This is the first study to robustly estimate the cost of risk-stratification for breast cancer screening. The cost of risk prediction using questionnaires and automated breast density measurement was low, but full economic evaluations including accurate costs are required to provide evidence of the cost-effectiveness of risk-stratified breast cancer screening. Highlights Economic evaluations have suggested that risk-stratified breast cancer screening may be a cost-effective use of resources in the United Kingdom.Current estimates of the cost of risk stratification are based on pragmatic assumptions.This study provides estimates of the cost of risk stratification using 3 strategies and when these strategies are implemented perfectly and imperfectly in the health system.The cost of risk stratification is relatively low unless single nucleotide polymorphisms are included in the strategy.
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Affiliation(s)
- Stuart J. Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Martin Eden
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Byers
- Division of Evolution and Genomic Science, The University of Manchester, Manchester, UK
- Manchester Centre of Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - D. Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Centre of Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Science, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Health Innovation Manchester, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Health Innovation Manchester, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
| | - Sacha J. Howell
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
- The Christie NHS Foundation Trust, Manchester, UK
| | - Anthony Howell
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
- The Christie NHS Foundation Trust, Manchester, UK
| | - David French
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
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Gorman LS, Ruane H, Woof VG, Southworth J, Ulph F, Evans DG, French DP. The co-development of personalised 10-year breast cancer risk communications: a 'think-aloud' study. BMC Cancer 2022; 22:1264. [PMID: 36471302 PMCID: PMC9721070 DOI: 10.1186/s12885-022-10347-3] [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: 06/30/2022] [Accepted: 11/21/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Risk stratified breast cancer screening is being considered as a means of improving the balance of benefits and harms of mammography. Stratified screening requires the communication of risk estimates. We aimed to co-develop personalised 10-year breast cancer risk communications for women attending routine mammography. METHODS We conducted think-aloud interviews on prototype breast cancer risk letters and accompanying information leaflets with women receiving breast screening through the UK National Breast Screening Programme. Risk information was redesigned following feedback from 55 women in three iterations. A deductive thematic analysis of participants' speech is presented. RESULTS Overall, participants appreciated receiving their breast cancer risk. Their comments focused on positive framing and presentation of the risk estimate, a desire for detail on the contribution of individual risk factors to overall risk and effective risk management strategies, and clearly signposted support pathways. CONCLUSION Provision of breast cancer risk information should strive to be personal, understandable and meaningful. Risk information should be continually refined to reflect developments in risk management. Receipt of risk via letter is welcomed but concerns remain around the acceptability of informing women at higher risk in this way, highlighting a need for co-development of risk dissemination and support pathways.
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Affiliation(s)
- Louise S. Gorman
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Helen Ruane
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Victoria G. Woof
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, MAHSC, Oxford Road, Manchester, M13 9PL UK
| | - Jake Southworth
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Fiona Ulph
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, MAHSC, Oxford Road, Manchester, M13 9PL UK
| | - D. Gareth Evans
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK ,grid.498924.a0000 0004 0430 9101Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Oxford Road, M13 9WL, Manchester, UK ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, MAHSC, Oxford Road, Manchester, M13 9PL UK ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England UK
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Alam MS, Shin D. Developing a tool for disability accommodation complexity: A sequential mixed study. Work 2022; 74:575-594. [PMID: 36278378 DOI: 10.3233/wor-210988] [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: 02/25/2023] Open
Abstract
BACKGROUND For disability accommodation (DA) decision-making/planning processes to unfold successfully, an understanding of the factors influencing DA complexity and a reliable tool for measuring such complexity are needed. The current literature does not provide sufficient knowledge on either topic. OBJECTIVE We attempted to explore the factors influencing DA complexity and develop a DA complexity scale in three phases through the sequential mixed approach. METHOD The study used an exploratory sequential mixed method in three phases. In phase 1, a qualitative survey of 335 supervisors with recent DA management experience was conducted, and the data were analyzed using a thematic approach to identify and evaluate DA complexity factors. In phase 2, qualitative results were transformed into items to construct a DA complexity scale. Later, the scale was tested using data from a separate quantitative cross-sectional survey of 303 supervisors with recent DA management experience. In phase 3, another quantitative cross-sectional study of 307 supervisors with recent DA management experience to evaluate the validity of the scale and its dimensions. RESULTS In Phase 1, we identified 12 factors influencing DA complexity. In Phase 2, the DA complexity scale loaded 29 items in nine dimensions, which represented the factors influencing DA complexity. In Phase 3, DA complexity positively influenced supervisors' job demand and stress, and negatively influenced their work motivation, organizational commitment, and supervisors' perceptions about their relationships with employees with disabilities. CONCLUSION This study enriches the DA literature by offering an in-depth understanding of DA complexity and a scale to measure it.
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Wright SJ, Dalal G, Vass CM, Georgsson S, Payne K. How do women want to receive information about non-invasive prenatal testing? Evidence from a discrete choice experiment. Prenat Diagn 2022; 42:1377-1389. [PMID: 36146928 PMCID: PMC9828485 DOI: 10.1002/pd.6243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Non-invasive prenatal testing (NIPT) identifies the risk of abnormalities in pregnancy, potentially reducing the risk of miscarriage associated with invasive tests. This study aimed to understand the preferences of current and future mothers about the content, format and timing of information provision about NIPT. METHODS An online discrete choice experiment was designed comprising four attributes: when in the pregnancy information is provided (4 levels); degree of detail (2 levels); information format (6 levels); cost to women for gathering information (5 levels). Respondents included women identified by an online-panel company in Sweden. The mathematical design was informed by D-efficient criteria. Choice data were analysed using uncorrelated random parameters logit and latent class models. RESULTS One thousand Swedish women (56% current mothers) aged 18-45 years completed the survey. On average, women preferred extensive information provided at/before 9 weeks of pregnancy. There was heterogeneity in preferences about the desired format of information provision (website, mobile app or individual discussion with a midwife) in the population. CONCLUSION Women had clear preferences about the desired content, format and timing of information provision about NIPT. It is important to tailor information provision to enable informed choices about NIPT.
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Affiliation(s)
- Stuart J. Wright
- Manchester Centre for Health EconomicsThe University of ManchesterManchesterUK
| | - Garima Dalal
- Manchester Centre for Health EconomicsThe University of ManchesterManchesterUK
| | - Caroline M. Vass
- Manchester Centre for Health EconomicsThe University of ManchesterManchesterUK,RTI Health SolutionsManchesterUK
| | | | - Katherine Payne
- Manchester Centre for Health EconomicsThe University of ManchesterManchesterUK
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Thompson K, Atkinson S, Kleyn M. Use of Online Newborn Screening Educational Resources for the Education of Expectant Parents: An Improvement in Equity. Int J Neonatal Screen 2022; 8:ijns8020034. [PMID: 35645288 PMCID: PMC9149957 DOI: 10.3390/ijns8020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
Educating parents about the newborn screening (NBS) process is critical in ensuring that families are aware of their child's NBS, which could contribute to better outcomes for the baby and experiences for the family. Successful education efforts result in expecting parents understanding the importance of NBS, feeling comfortable with the NBS process, and being aware of their choices after NBS is complete. Educating parents prenatally is challenging for many NBS programs for a variety of reasons. The COVID-19 pandemic added additional barriers to NBS programs' ability to educate parents prenatally about NBS. By initiating a department-wide partnership among other programs with a similar target audience, Michigan's NBS Program was able to host a virtual baby fair. Since the inaugural event, Michigan's NBS Program has hosted seven virtual fairs with 15 participating programs. A total of 692 participants registered for the baby fair and received a resource packet, over 157 participants joined one of the live presentations, and 211 have viewed the YouTube videos of recorded fairs. Virtual baby fairs are a cost-effective and convenient approach to education that could be implemented in any NBS program to educate parents prenatally about NBS.
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White AL, Boardman F, McNiven A, Locock L, Hinton L. Absorbing it all: A meta-ethnography of parents' unfolding experiences of newborn screening. Soc Sci Med 2021; 287:114367. [PMID: 34534781 PMCID: PMC8505793 DOI: 10.1016/j.socscimed.2021.114367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/21/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Ashley L White
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
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Kariyawasam DS, D'Silva AM, Vetsch J, Wakefield CE, Wiley V, Farrar MA. " We needed this": perspectives of parents and healthcare professionals involved in a pilot newborn screening program for spinal muscular atrophy. EClinicalMedicine 2021; 33:100742. [PMID: 33842861 PMCID: PMC8020144 DOI: 10.1016/j.eclinm.2021.100742] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Newborn screening (NBS) for spinal muscular atrophy (SMA) is a recognised model through which health outcomes can be improved. However, perspectives of parents and healthcare professionals (HCPs) involved in such programs are largely unknown. METHODS A pilot program for SMA ran from August 2018-July 2020. Using a mixed-methods convergent methodology, we used a self-administered questionnaire to understand parents' perceptions and psychological impact of the program from diagnosis to treatment. We thematically analysed successes/challenges encountered by HCPs and recommendations for service improvement from both participant groups. FINDINGS 202,388 infants were screened for SMA and the perceptions of 44 parents and HCPs affected by a positive result in eighteen newborns was ascertained. Parents (n=29, 100%) were satisfied with NBS for SMA. Although screen-positive result was distressing for all parents, quality of life improved over time [CarerQoL-7D baseline median score 4 (SD=1.4) vs six-month median score 8 (SD=1.3), p<0.001)]. Challenges for HCPs included managing the time-critical nature of the pathway whilst remaining cognisant of limitations associated with the predictive screening test. INTERPRETATION Interpretation: NBS for SMA fulfils criteria for population-wide screening. Net benefits are acknowledged by stakeholders to optimise lifelong outcomes. Harms including psychological distress associated with a screen-positive result may be managed by targeted psychosocial support, information provision and a personalised model of care together strengthening healthcare systems. FUNDING The NSW Pilot NBS study was funded by Luminesce Alliance. Dr Kariyawasam received funding from the RTP Scholarship, University of New South Wales and The Freedman Family Foundation Scholarship, Sydney Children's Hospital Foundation.
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Affiliation(s)
- Didu S.T. Kariyawasam
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
| | - Arlene M. D'Silva
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Veronica Wiley
- NSW Newborn Screening Program, Children's Hospital Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle A. Farrar
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
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IJzebrink A, van Dijk T, Franková V, Loeber G, Kožich V, Henneman L, Jansen M. Informing Parents about Newborn Screening: A European Comparison Study. Int J Neonatal Screen 2021; 7:ijns7010013. [PMID: 33652810 PMCID: PMC7930998 DOI: 10.3390/ijns7010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Knowledge about newborn screening (NBS) is an important factor for parents to make an informed decision about participation. In Europe, countries inform parents differently about their NBS program, potentially including different knowledge aspects in their information. The aim of this study was to assess twenty-six European parental information products and to analyze their knowledge aspects through a content analysis. The analyzed aspects were compared to a list of eight knowledge aspects from scientific literature. The list includes aspects important for parents' decision-making, such as the purpose of screening. The study showed that most of the eight knowledge aspects are included in NBS information products of the majority of countries. However, there were differences between countries, for example in the amount of detail and phrasing of the information. Additional relevant knowledge aspects have also been identified and are recommended to optimize information products, such as the handling of residual bloodspot samples. This study only assessed knowledge aspects in information products meant for printing, but many countries also use other communication methods, and the impact on knowledge of the delivery of the information needs further study. Preferences of parents on alternative communication methods need to be considered and evaluated on their effectiveness.
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Affiliation(s)
- Amber IJzebrink
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
| | - Tessa van Dijk
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
| | - Věra Franková
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital Praque, 128 08 Prague 2, Czech Republic; (V.F.); (V.K.)
- Institute for Medical Humanities, First Faculty of Medicine, Charles University Praque, 128 08 Praque 2, Czech Republic
| | - Gerard Loeber
- International Society for Neonatal Screening, 3721CK Bilthoven, The Netherlands;
| | - Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital Praque, 128 08 Prague 2, Czech Republic; (V.F.); (V.K.)
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
| | - Marleen Jansen
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
- Centre for Health Protection, National Institue for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
- Correspondence: ; Tel.: +31-20-444-3869
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Franková V, Driscoll RO, Jansen ME, Loeber JG, Kožich V, Bonham J, Borde P, Brincat I, Cheillan D, Dekkers E, Fingerhut R, Kuš IB, Girginoudis P, Groselj U, Hougaard D, Knapková M, la Marca G, Malniece I, Nanu MI, Nennstiel U, Olkhovych N, Oltarzewski M, Pettersen RD, Racz G, Reinson K, Salimbayeva D, Songailiene J, Vilarinho L, Vogazianos M, Zetterström RH, Zeyda M. Regulatory landscape of providing information on newborn screening to parents across Europe. Eur J Hum Genet 2020; 29:67-78. [PMID: 33040093 DOI: 10.1038/s41431-020-00716-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022] Open
Abstract
Newborn screening (NBS) is an important part of public healthcare systems in many countries. The provision of information to parents about NBS is now recognised as an integral part of the screening process. Informing parents on all aspects of screening helps to achieve the benefits, promote trust and foster support for NBS. Therefore, policies and guidelines should exist to govern how the information about NBS is provided to parents, taking into account evidence-based best practices. The purpose of our survey was to explore whether any legally binding provisions, guidelines or recommendations existed pertaining to the provision of information about NBS to parents across Europe. Questions were designed to determine the regulatory process of when, by whom and how parents should be informed about screening. Twenty-seven countries participated in the survey. The results indicated that most countries had some sort of legal framework or guidelines for the provision of information to parents. However, only 37% indicated that the provision of information was required prenatally. The majority of countries were verbally informing parents with the aid of written materials postnatally, just prior to sample collection. Information was provided by a neonatologist, midwife or nurse. A website dedicated to NBS was available for 67% of countries and 89% had written materials about NBS for parents. The survey showed that there is a lack of harmonisation among European countries in the provision of information about NBS and emphasised the need for more comprehensive guidelines at the European level.
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Affiliation(s)
- Věra Franková
- Department of Paediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital, Prague, Czech Republic. .,Institute for Medical Humanities, Charles University First Faculty of Medicine, Prague, Czech Republic.
| | - Riona O Driscoll
- Department of Paediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Marleen E Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J Gerard Loeber
- International Society for Neonatal Screening Office, Bilthoven, The Netherlands
| | - Viktor Kožich
- Department of Paediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital, Prague, Czech Republic.
| | - James Bonham
- Division of Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffiled, UK
| | | | | | | | - Eugenie Dekkers
- RIVM Centre for Population Screening, Bilthoven, The Netherlands
| | | | | | | | - Urh Groselj
- UMC-University Children's Hospital, Ljubljana, Slovenia
| | | | - Mária Knapková
- Children's University Hospital, Banska Bystrica, Slovakia
| | | | | | - Michaela Iuliana Nanu
- National Health Programs Management Unit of National Institute for Mother & Child Health, Bucharest, Romania
| | - Uta Nennstiel
- Screening Center of the Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | | | | | - Rolf D Pettersen
- Norwegian National Unit for Newborn Screening, Oslo University Hospital, Oslo, Norway
| | - Gabor Racz
- Department of Paediatrics, University of Szeged, Szeged, Hungary
| | | | - Damilya Salimbayeva
- Scientific centre of Gynaecology, Obstetrics and Perinatology, Almaty, Kazakhstan
| | | | - Laura Vilarinho
- National Institute of Health Dr Ricardo Jorge, Porto, Portugal
| | | | - Rolf H Zetterström
- Centre for inherited metabolic diseases, Karolinska University Hospital, Solna, Sweden
| | - Maximilian Zeyda
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Armstrong RE, Frith L, Ulph FM, Southern KW. Constructing a Bioethical Framework to Evaluate and Optimise Newborn Bloodspot Screening for Cystic Fibrosis. Int J Neonatal Screen 2020; 6:40. [PMID: 33073032 PMCID: PMC7422997 DOI: 10.3390/ijns6020040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Newborn bloodspot screening for cystic fibrosis is a valid public health strategy for populations with a high incidence of this inherited condition. There are a wide variety of approaches to screening and in this paper, we propose that a bioethical framework is required to determine the most appropriate screening protocol for a population. This framework depends on the detailed evaluation of the ethical consequences of all screening outcomes and placing these in the context of the genetic profile of the population screened, the geography of the region and the healthcare resources available.
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Affiliation(s)
- Rachael E Armstrong
- Department of Women's and Children's Health, University of Liverpool, Liverpool L12 2AP, UK;
| | - Lucy Frith
- Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK;
| | - Fiona M Ulph
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK;
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool L12 2AP, UK;
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Ulph F, Dharni N, Bennett R, Lavender T. Consent for newborn screening: screening professionals' and parents' views. Public Health 2019; 178:151-158. [PMID: 31698137 DOI: 10.1016/j.puhe.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/23/2019] [Accepted: 08/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Expansion of newborn bloodspot screening (NBS) within England, which practices an informed consent model, justified examining acceptability and effectiveness of alternative consent models. STUDY DESIGN Qualitative focus groups. METHODS Forty-five parents and 37 screening professionals (SPs) participated. Data were analysed using thematic analysis. RESULTS Parents and SPs initially appeared to have differing views about appropriate consent models. Most parents accepted assumed consent, if adequately informed; however, once aware of bloodspot storage, informed consent was wanted. SPs valued informed consent, but acknowledged it was difficult to obtain. Both samples wanted parents to be informed but were unclear how this could be achieved. Most parents felt NBS was not presented as optional. CONCLUSION The simultaneous exploration of parents and SPs views, in real time is original. This rigour avoided the reliance on retrospective accounts which make it difficult to establish how decisions were made at the time. It is also unique in providing pre-interview consent models to drive the depth of data. It was rigorous in member checking. Findings suggested a preference for full disclosure of all information with some parents valuing this more than choice. Both samples queried whether current consent was sufficiently informed and voluntary. Results suggest differing tolerances of consent type if screening is solely for diagnostic purposes vs bloodspot storage. Results highlight the need for caution when examining consent model preferences without also checking knowledge, as opinions may be based on incomplete knowledge. Future research is needed to examine efficacy of proposed changes. FUNDING National Institute for Health Research Health Technology Assessment HTAProgramme (11/62/02). TRIAL REGISTRATION ISRCTN70227207.
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Affiliation(s)
- F Ulph
- University of Manchester, United Kingdom.
| | - N Dharni
- University of Manchester, Now Bradford Institute for Health Research, United Kingdom
| | - R Bennett
- University of Manchester, United Kingdom
| | - T Lavender
- University of Manchester, United Kingdom
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John NM, Wright SJ, Gavan SP, Vass CM. The role of information provision in economic evaluations of non-invasive prenatal testing: a systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1123-1131. [PMID: 31230226 PMCID: PMC6803567 DOI: 10.1007/s10198-019-01082-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Technological progress has led to changes in the antenatal screening programmes, most significantly the introduction of non-invasive prenatal testing (NIPT). The availability of a new type of testing changes the type of information that the parent(s) require before, during and after screening to mitigate anxiety about the testing process and results. OBJECTIVES To identify the extent to which economic evaluations of NIPT have accounted for the need to provide information alongside testing and the associated costs and health outcomes of information provision. METHODS A systematic review of economic evaluations of NIPTs (up to February 2018) was conducted. Medline, Embase, CINAHL and PsychINFO were searched using an electronic search strategy combining a published economic search filter (from NHS economic evaluations database) with terms related to NIPT and screening-related technologies. Data were extracted using the Consolidated Health Economic Evaluation Reporting Standards framework and the results were summarised as part of a narrative synthesis. RESULTS A total of 12 economic evaluations were identified. The majority of evaluations (n = 10; 83.3%) involved cost effectiveness analysis. Only four studies (33.3%) included the cost of providing information about NIPT in their economic evaluation. Two studies considered the impact of test results on parents' quality of life by allowing utility decrements for different outcomes. Some studies suggested that the challenges of valuing information prohibited their inclusion in an economic evaluation. CONCLUSION Economic evaluations of NIPTs need to account for the costs and outcomes associated with information provision, otherwise estimates of cost effectiveness may prove inaccurate.
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Affiliation(s)
- Nikita M John
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Stuart J Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Caroline M Vass
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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18
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Nisselle A, Bishop M, Charles T, Morrissy S, King E, Metcalfe S, Gaff C. Lessons learnt from implementing change in newborn bloodspot screening processes over more than a decade: Midwives, genetics and education. Midwifery 2019; 79:102542. [PMID: 31569029 DOI: 10.1016/j.midw.2019.102542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/09/2019] [Accepted: 09/21/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore midwives' roles and education requirements in newborn bloodspot screening (NBS) for genetic conditions, as programs and supporting education evolve over time. BACKGROUND NBS processes are evolving and will continue to evolve with new genetic and genomic technologies. Midwives have a critical role in facilitating NBS, as they are the primary healthcare professional to interact with parents at the time of collecting the bloodspot. As new consent processes and genomic technologies are incorporated into NBS, midwives need to stay up-to-date with these changes, so that parents can make an informed decision about having the test and future use of the DNA sample. RESEARCH DESIGN/SETTING We used a cross-sectional approach to analyse midwives' knowledge and behaviour in 2005/6 and 2016, with changes in NBS processes and education introduced in 2011. FINDINGS We found midwives' NBS knowledge improved in 8/18 areas after a 10-year period, mostly related to process changes, but there was also an increase in misconceptions regarding which conditions are screened. Areas of significant improvement were not consistently explained by participation in continuing professional development (CPD). We found midwives used official brochures and NBS collection cards to guide discussions with families. Changes to the NBS collection cards, together with the content of CPD materials, aligned with the significant improvements and deficits we observed. When considering potential changes to future maternity care that incorporates emerging genomic technologies, midwives indicated the main barrier was their lack of knowledge; the majority (60.3%) reported supervision support to attend genomics CPD. KEY CONCLUSIONS Changes in NBS practice should be implemented through multifaceted programs that include education sessions and procedural prompts. The NBS collection card should be seen not just as a legal consent document but also as an educational tool. IMPLICATIONS FOR PRACTICE As NBS programs evolve through the addition of conditions screened for or changes to technology or consent processes, multiple strategies should be applied to upskill midwives to ensure they can best support parents to make informed choices.
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Affiliation(s)
- Amy Nisselle
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; The University of Melbourne, Parkville, VIC 3052, Australia.
| | - Michelle Bishop
- Genomics Education Program, Health Education England, Hagley Road, Birmingham B16 9RG, United Kingdom.
| | - Taryn Charles
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; The University of Melbourne, Parkville, VIC 3052, Australia; Victorian Clinical Genetics Services, Flemington Rd, Parkville, VIC 3052, Australia.
| | - Sally Morrissy
- Victorian Clinical Genetics Services, Flemington Rd, Parkville, VIC 3052, Australia.
| | - Emily King
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; The University of Melbourne, Parkville, VIC 3052, Australia.
| | - Sylvia Metcalfe
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; The University of Melbourne, Parkville, VIC 3052, Australia.
| | - Clara Gaff
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; The University of Melbourne, Parkville, VIC 3052, Australia; Walter & Eliza Hall Institute of Medical Research, Royal Parade, Parkville, VIC 3052, Australia.
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19
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Factors Influencing Parental Awareness about Newborn Screening. Int J Neonatal Screen 2019; 5:35. [PMID: 33072994 PMCID: PMC7510194 DOI: 10.3390/ijns5030035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022] Open
Abstract
Appropriate and timely education about newborn screening (NBS) helps to foster benefits such as prompt follow up, to promote parents' autonomy via informed consent and minimize the harms such as reducing the impact of NBS false-positive results. The aim of this study was to ascertain how mothers are informed about NBS in the Czech Republic and to identify the variables associated with awareness about NBS. The questionnaires evaluating awareness and its determinants were mailed to a random sample of 3000 mothers 3 months post-delivery. The overall response rate was 42%. We analysed 1100 questionnaires and observed that better awareness about NBS was significantly associated with age, parity, number of information sources, child health status, size of maternity hospital and an obstetrician as the source of prenatally obtained information. Although the majority of mothers (77%) in our study recalled being informed by a physician or nurse in the neonatal ward, results have revealed that over 40% of participants did not have sufficient awareness about the principal aspects of NBS. Several measures including seminars for healthcare providers and the development and distribution of new educational materials were adopted to improve parental education about NBS in the Czech Republic.
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Nicholls SG, Etchegary H, Tessier L, Simmonds C, Potter BK, Brehaut JC, Pullman D, Hayeems RZ, Zelenietz S, Lamoureux M, Milburn J, Turner L, Chakraborty P, Wilson BJ. What is in a Name? Parent, Professional and Policy-Maker Conceptions of Consent-Related Language in the Context of Newborn Screening. Public Health Ethics 2019; 12:158-175. [PMID: 31384304 PMCID: PMC6655345 DOI: 10.1093/phe/phz003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents (n = 32), healthcare professionals (n = 19) and policy decision makers (n = 17) in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities (including disclosure of information and time to review); parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs.
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Affiliation(s)
- Stuart G Nicholls
- School of Epidemiology and Public Health, University of Ottawa and Ottawa Hospital Research Institute (OHRI)
| | - Holly Etchegary
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Laure Tessier
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa
| | - Jamie C Brehaut
- School of Epidemiology and Public Health, University of Ottawa and Ottawa Hospital Research Institute (OHRI)
| | - Daryl Pullman
- Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Robin Z Hayeems
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children and The Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Sari Zelenietz
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario
| | - Lesley Turner
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario and Department of Pediatrics, Faculty of Medicine, University of Ottawa
| | - Brenda J Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland
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Psychological Impact on Parents of an Inconclusive Diagnosis Following Newborn Bloodspot Screening for Cystic Fibrosis: A Qualitative Study. Int J Neonatal Screen 2019; 5:23. [PMID: 33072982 PMCID: PMC7510205 DOI: 10.3390/ijns5020023] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/28/2019] [Indexed: 02/02/2023] Open
Abstract
Genetic results of uncertain clinical significance are being returned to parents following newborn screening, representing a paradigm change in how society considers health and illness. 'Cystic Fibrosis screen positive, inconclusive diagnosis' (CFSPID) is a designation given to newborns with a positive screening result for, but not a definitive diagnosis of, cystic fibrosis. We explored the psychological impact of receiving a CFSPID result on parents. Five semi-structured interviews were conducted with eight parents whose children have CFSPID. Interpretative phenomenological analysis identified these themes: "The way we were told": 'diagnosis as a traumatic event' focused on how parents were distressed and dissatisfied by the initial screening result communication, 'Facing and challenging traditional ideas about health and illness' explored the emerging problem of how CFSPID does not fit the commonly accepted medical model, and 'Making certainty out of uncertainty' explored the varying strategies parents developed to adapt to the uncertainty regarding their child's prognosis. Findings suggest that CFSPID results caused parents' distress, initiated with the first communication of the result and persisting thereafter. Our data suggests approaches to the delivery of CFSPID results that may reduce the impact. Work is needed to close the gap between healthcare advances and societies commonly held medical model.
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Vass CM, Georgsson S, Ulph F, Payne K. Preferences for aspects of antenatal and newborn screening: a systematic review. BMC Pregnancy Childbirth 2019; 19:131. [PMID: 30991967 PMCID: PMC6469127 DOI: 10.1186/s12884-019-2278-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries offer screening programmes to unborn and newborn babies (antenatal and newborn screening) to identify those at risk of certain conditions to aid earlier diagnosis and treatment. Technological advances have stimulated the development of screening programmes to include more conditions, subsequently changing the information required and potential benefit-risk trade-offs driving participation. Quantifying preferences for screening programmes can provide programme commissioners with data to understand potential demand, the drivers of this demand, information provision required to support the programmes and the extent to which preferences differ in a population. This study aimed to identify published studies eliciting preferences for antenatal and newborn screening programmes and provide an overview of key methods and findings. METHODS A systematic search of electronic databases for key terms identified eligible studies (discrete choice experiments (DCEs) or best-worst scaling (BWS) studies related to antenatal/newborn testing/screening published between 1990 and October 2018). Data were systematically extracted, tabulated and summarised in a narrative review. RESULTS A total of 19 studies using a DCE or BWS to elicit preferences for antenatal (n = 15; 79%) and newborn screening (n = 4; 21%) programmes were identified. Most of the studies were conducted in Europe (n = 12; 63%) but there were some examples from North America (n = 2; 11%) and Australia (n = 2; 11%). Attributes most commonly included were accuracy of screening (n = 15; 79%) and when screening occurred (n = 13; 68%). Other commonly occurring attributes included information content (n = 11; 58%) and risk of miscarriage (n = 10; 53%). Pregnant women (n = 11; 58%) and healthcare professionals (n = 11; 58%) were the most common study samples. Ten studies (53%) compared preferences across different respondents. Two studies (11%) made comparisons between countries. The most popular analytical model was a standard conditional logit model (n = 11; 58%) and one study investigated preference heterogeneity with latent class analysis. CONCLUSION There is an existing literature identifying stated preferences for antenatal and newborn screening but the incorporation of more sophisticated design and analytical methods to investigate preference heterogeneity could extend the relevance of the findings to inform commissioning of new screening programmes.
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Affiliation(s)
- Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | | | - Fiona Ulph
- Division of Psychology & Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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