Exploring the Role of Religiosity and Spirituality in Amniocentesis Decision‐Making Among Latinas

The rapid clinical implementation of cell-free DNA (cfDNA) screening, a non-invasive method of prenatal genetic screening, has outpaced research on its social and ethical implications. This study is the first to compare the ethical and practical views of Spanish- and English-speaking pregnant women in the United States about cfDNA screening. Semi-structured interviews were conducted with diverse Spanish- and English-speaking women who had received prenatal care at a large academic medical center. Of the 24 interviewees, ten were Latinas who were interviewed in Spanish; English-language interviews were conducted with seven non-Hispanic Asian and seven non-Hispanic White women. Participants held positive opinions concerning the accuracy of cfDNA screening and often noted that it would enhance preparedness. Participants also expressed concerns about the possibility of inaccurate results and the potentially negative effects of cfDNA screening on the experience of pregnancy. Differences emerged between Spanish and English speakers in their portrayals of their relationships with prenatal health care providers, the extent to which they questioned providers’ advice, their ethical concerns, and their informational needs. We emphasize the importance of customizing prenatal test counseling to the needs of the individual patient, providing educationally appropriate counseling and literature, and mitigating potential language barriers.

Section: Discussionmentioning

confidence: 99%

Spanish‐ and English‐Speaking Pregnant Women's Views on cfDNA and Other Prenatal Screening: Practical and Ethical Reflections

Floyd

Allyse²,

Michie

2016

“…Studies of prenatal decision-making among lowincome Latina women identified important differences from white middle class women. For example, low-income Latina women tended to be more accustomed to receiving prescriptive medical advice from health care providers; therefore, the shared decision-making approach taken by the GC was often misconstrued as a sign that the intervention was not truly needed or left the patient confused about the nature of the appointment (Browner and Preloran 1999;Browner et al 2003;Seth et al 2011;Sheets et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Cancer Counseling of Low‐Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision‐Making

Kamara

Weil

Youngblom

et al. 2017

In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains - Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators - that reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.

“…In contrast, spirituality is widely-acknowledged to have a broader definition than religiosity in which both religious and nonreligious perspectives are encompassed, as spirituality is not restricted by the boundaries of any one religious tradition and is frequently a self-defined concept (Breen et al 2006;McCarthy Veach et al 2003;Price et al 2007;Ramondetta et al 2013). Spirituality often centers on the search for meaning or purpose in life, and spiritual beliefs and practices aid a person in looking outside of the self for support and/or guidance in crisis situations (Breen et al 2006;D'Souza 2007;Seth et al 2011;Weil 2000).…”

mentioning

confidence: 99%

“…Although not all patients will overtly make known their wish for a discussion of spiritual matters, many patients express this desire through the incorporation of subtle spiritual language into their conversations (Byrne 2007;Koenig & Brenner Carson 2004;McEvoy et al 2014). Continuing the discussion of religiosity/spirituality with those patients who provide hints of their beliefs may not only enhance the experience of the encounter itself, but also establish a secure foundation should an abnormality indeed by found later in the pregnancy (Breen et al 2006;Saguil & Phelps 2012;Seth et al 2011).…”

mentioning

confidence: 99%

Spiritual Exploration in the Prenatal Genetic Counseling Session

Sagaser¹,

Hashmi²,

Carter³

et al. 2016

Religion and spirituality (R/S) are important components of many individuals’ lives, and spirituality is often employed by women coping with pregnancy complications. To characterize how prenatal genetic counselors might address spiritual issues with patients, 283 English and Spanish speaking women receiving prenatal genetic counseling in Houston, Texas were surveyed post‐counseling using both the Brief RCope and questions regarding interest in spiritual exploration. Genetic counselors were concurrently surveyed to identify religious/spiritual language used within sessions and perceived importance of R/S. Genetic counselors were significantly more likely to identify R/S as important to a patient when patients used religious/spiritual language (p < 0.001). Conversely, when no religious/spiritual terms were present, the counselor felt uncertain about the importance of R/S 63 % of the time. However, 67 % of patients reported that they felt comfortable sharing their faith as it relates to their pregnancy, and 93 % reported using positive religious coping. Less than 25 % reported a desire for overt religious actions such as prayer or scripture exploration. Therefore, most patients’ desires for spiritual exploration center in the decision making and coping processes that are in line with the genetic counseling scope of practice. Thus, counselors should feel empowered to incorporate spiritual exploration into their patient conversations.