Evidence-based obstetric ethics and informed decision-making by pregnant women about invasive diagnosis after first-trimester assessment of risk for trisomy 21

Nicolaides, Kypros H.; Chervenak, Frank A.; McCullough, Laurence B.; Avgidou, K.; Papageorghiou, Aris T.

doi:10.1016/j.ajog.2005.02.134

Cited by 109 publications

(69 citation statements)

References 15 publications

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“…While research suggests that women can effectively incorporate such risk information into their decision making, [11] decisions regarding amniocentesis are influenced by the a priori risk level, [12] and do not appear to always correlate clinically with the test results received. [13,14] Of course, personal beliefs also influence decisions about invasive testing, including confidence that the results would not change behavior, mistaken beliefs that "negative" screening test results imply no risk, [15,16] and failures of the screening test to reassure.…”

Section: Commentmentioning

confidence: 99%

Does labeling prenatal screening test results as negative or positive affect a woman’s responses?

Zikmund‐Fisher

Fagerlin

Keeton

et al. 2007

American Journal of Obstetrics and Gynecology

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Objective-We tested whether adding interpretive labels (e.g., "negative test") to prenatal genetic screening test results changes perceived risk and preferences for amniocentesis.Study Design-Women (N=1,688) completed a hypothetical pregnancy scenario via the Internet. We randomized participants into two groups: high (12.5/1000) risk of fetal chromosomal problems or low (2/1000) risk. After prenatal screening, estimated risk was identical (5/1000) for all participants, but results were provided either alone or with interpretive labels.Results-When receiving test results without labels, all participants react similarly. With labels, participants receiving "positive" or "abnormal" results reported higher perceived risk (p<0.001), greater worry (p<0.001), and greater interest in amniocentesis (57% vs. 37%, p<0.001) than those receiving "negative" or "normal" results. Conclusions-Interpretive labels for test results can induce larger changes to women's risk perceptions and behavioral intentions than numerical results alone do, creating decision momentum. This finding has broad clinical implications for patient-provider communication.

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Section: Commentmentioning

confidence: 99%

Does labeling prenatal screening test results as negative or positive affect a woman’s responses?

Zikmund‐Fisher

Fagerlin

Keeton

et al. 2007

American Journal of Obstetrics and Gynecology

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“…Physicians should assume that, with adequate counseling and support, pregnant women are indeed capable of making scientifically disciplined decisions, if informed consent is appropriately evidence based, as has been shown for decision making about invasive prenatal diagnosis after first-trimester risk assessment. 17 …”

Section: Resultsmentioning

confidence: 99%

The perils of the imperfect expectation of the perfect baby

Chervenak

McCullough

Brent

2010

American Journal of Obstetrics and Gynecology

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“…Studies show that few women read about and actively prepare themselves for the examination (36,37). Another study concludes that pregnant women are able to use sophisticated methods of screening information in order to make scientifically and ethically rational decisions (38). The implications of this are clear:…”

Section: Making Decisions While In a State Of Emotional Chaosmentioning

confidence: 99%

Kvinners erfaringer i møtet med abortnemnda ved sene svangerskapsbrudd

Sommerseth¹,

Sundby²

2007

Sykepleien

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Det må ikke kopieres fra denne boka i strid med åndsverkloven eller med avtaler om kopiering inngått med Kopinor, interesseorgan for rettighetshavere til åndsverk.Omslag: Inger Sandved Anfinsen. Trykk og innbinding: AiT e-dit AS.Produsert i samarbeid med Unipub, Oslo. Avhandlingen blir kun produsert av Unipub i forbindelse med disputas. Alle henvendelser vedrørende avhandlingen skal rettes til rettighetshaver eller enheten der doktorgrad er forsvart. 5 SammendragHensikten med denne avhandlingen er å frembringe kunnskap om de erfaringer kvinner har gjort når den rutinemessige ultralydundersøkelsen viser noe unormalt med fosteret.Den visuelle fremstillingen av fosteret i mors liv har gitt oss tilgang til en type informasjon og kunnskap som vi ikke kjente til for bare få år siden. Men moderne ultralyddiagnostikk viser også at ny kunnskap skaper nye problemstillinger, praktisk og etisk.Når kvinner oppsøker dette tilbudet, møter de med en forventning om å dra hjem med et visuelt bilde av et normalt foster. Men uventet diagnostisk informasjon kan føre til at de isteden havner i en situasjon der de med liten tid til rådighet må ta stilling til eksistensielle verdivalg, som for eksempel å velge om svangerskapet kan fullføres. Dette kan endre en normal graviditet preget av forventning til en graviditet preget av eksistensiell krise og ambivalens.Lov om bioteknologi har satt et skille mellom tilbud om fosterdiagnostikk og tilbud om rutinemessig ultralyd. Dette er et skille som fagfolk synes det er vanskelig å praktisere i den kliniske hverdagen (Salvesen, 2004). Det henger sammen med at apparaturen stadig blir bedre og gir muligheter for ytterligere detaljerte undersøkelser når fosterets anatomi gjennomgås. En konsekvens av dette er at mistanke om utviklingsavvik og kromosomanomalier i stadig større grad blir et sentralt tema ved den ordinaere ultralydundersøkelsen, men uten at kvinnen er bedre forberedt på å motta denne nye informasjonen. Dermed kan flere kvinner havne i en situasjon der uventet diagnostisk informasjon stiller dem overfor en verdikonflikt de ikke er tilstrekkelig forberedt på. Utgangspunktet for analysen er inspirert av fenomenologisk forskning (Bengtsson, 1993. Tilnaermingen var Kvale's fem steg for menings fortetting . Intervjuene ble først transkribert ordrett. SummaryThe objective of this dissertation is to better understand women's experiences when routine ultrasound scan shows abnormalities with the fetus.The ultrasound picture of the fetus in the mother's womb has in the past few years given us access to new information and knowledge. But modern ultrasound diagnostics also show that new knowledge creates new practical and ethical dilemmas.When women approach the ultrasonic investigation they expect to take home a picture of a healthy fetus. But unexpected findings may have the consequence that women have to make existential choices of value under heavy time pressure. One possible choice is whether the pregnancy should be terminated or not. This may change a normal pregnancy of expectation to a pr...

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Evidence-based obstetric ethics and informed decision-making by pregnant women about invasive diagnosis after first-trimester assessment of risk for trisomy 21

Cited by 109 publications

References 15 publications

Does labeling prenatal screening test results as negative or positive affect a woman’s responses?

Does labeling prenatal screening test results as negative or positive affect a woman’s responses?

The perils of the imperfect expectation of the perfect baby

Kvinners erfaringer i møtet med abortnemnda ved sene svangerskapsbrudd

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