Parental Attitudes toward Ethical and Social Issues Surrounding the Expansion of Newborn Screening Using New Technologies

Hasegawa, Lianne; Fergus, Kathleen; Ojeda, Norma; Au, Sylvia Mann

doi:10.1159/000314644

Cited by 53 publications

(57 citation statements)

References 75 publications

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“…Participants' strong acceptance of NBS for several different conditions, including fatal neurological disorders, is significant and in line with other studies across the United States and European Union (Brunger et al, 2000;Lipstein et al, 2010;Plass et al, 2010;Hasegawa et al, 2011). Together, these findings suggest that Wilson and Junger's screening principles should be updated to include a broader concept of benefit than medical treatment (Hasegawa et al, 2011) and also challenge critics of NBS expansion who argue that a disorder should only be included in a screening panel if an effective treatment exists (Botkin et al, 2006). While our respondents overwhelmingly indicated that they would be interested in newborn testing to be prepared for the birth of a child with a genetic disorder, a large majority also agreed that they would use information from newborn testing for fatal neurological disorders in their future reproductive decisions.…”

supporting

confidence: 79%

Interest in Newborn Genetic Testing: A Survey of Prospective Parents and the General Public

Etchegary

Dicks

Green

et al. 2012

Genetic Testing and Molecular Biomarkers

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supporting

confidence: 79%

Interest in Newborn Genetic Testing: A Survey of Prospective Parents and the General Public

Etchegary

Dicks

Green

et al. 2012

Genetic Testing and Molecular Biomarkers

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“…65 The review also suggested that there could be differences in parents' and health professionals' views regarding the timing of information provision and consent models. 91 As this may explain one of the barriers to effective NBS, it is important that future research examines this. However, one of the issues that this review highlights is the difficulty of comparing midwives' (or health professionals') views with those of parents if the research is conducted at different time points, as changes in screening could account for differences in opinion.…”

Section: Discussionmentioning

confidence: 99%

“…being included in the review, 8,12,14,15,17,19,20,25,26,[28][29][30]33, covering NBS in a number of different countries: England (n = 11 8,14,25,62,66,70,72,[78][79][80]83 ), Wales (n = 2 85,86 ), France (n = 1 89 ), Germany (n = 1 15 ), the Netherlands (n = 1 29 ), USA (n = 20 17,19,26,30,33,61,63,64,71,[74][75][76]81,82,84,87,88,90,91,93 ), Canada (n = 4 12,65,…”

Section: Theories Of Informed Consent: Developing An Analytical Framementioning

confidence: 99%

Provision of information about newborn screening antenatally: a sequential exploratory mixed-methods project

Ulph

Wright

Dharni

et al. 2017

Health Technol Assess

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BackgroundParticipation in the UK Newborn Bloodspot Screening Programme (NBSP) requires parental consent but concerns exist about whether or not this happens in practice and the best methods and timing to obtain consent at reasonable cost.ObjectivesTo collate all possible modes of prescreening communication and consent for newborn (neonatal) screening (NBS); examine midwives’, screening professionals’ and users’ views about the feasibility, efficiency and impact on understanding of each; measure midwives’ and parents’ preferences for information provision; and identify key drivers of cost-effectiveness for alternative modes of information provision.DesignSix study designs were used: (1) realist review – to generate alternative communication and consent models; (2) qualitative interviews with parents and health professionals – to examine the implications of current practice for understanding and views on alternative models; (3) survey and observation of midwives – to establish current costs; (4) stated preference surveys with midwives, parents and potential future parents – to establish preferences for information provision; (5) economic analysis – to identify cost-effectiveness drivers of alternative models; and (6) stakeholder validation focus groups and interviews – to examine the acceptability, views and broader impact of alternative communication and consent models.SettingProviders and users of NBS in England.ParticipantsStudy 2: 45 parents and 37 health professionals; study 3: 22 midwives and eight observations; study 4: 705 adults aged 18–45 years and 134 midwives; and study 6: 12 health-care professionals and five parents.ResultsThe realist review identified low parental knowledge and evidence of coercive consent practices. Interview, focus group and stated preference data suggested a preference for full information, with some valuing this more than choice. Health professionals preferred informed choice models but parents and health professionals queried whether or not current consent was fully informed. Barriers to using leaflets effectively were highlighted. All studies indicated that a ‘personalised’ approach to NBS communication, allowing parents to select the mode and level of information suited to their learning needs, could have added value. A personalised approach should rely on midwife communication and should occur in the third trimester. Overall awareness was identified as requiring improvement. Starting NBS communication by alerting parents that they have a choice to make and telling them that samples could be stored are both likely to enhance engagement. The methods of information provision and maternal anxiety causing additional visits to health-care professionals were the drivers of relative cost-effectiveness. Lack of data to populate an economic analysis, confirmed by value of information analysis, indicated a need for further research.LimitationsThere are some limitations with regard to the range of participants used in studies 2 and 3 and so caution should be exercised when interpreting some of the results.ConclusionsThis project highlighted the importance of focusing on information receipt and identified key communication barriers. Health professionals strongly preferred informed consent, which parents endorsed if they were made aware of sample storage. Uniform models of information provision were perceived as ineffective. A choice of information provision was supported by health professionals and parents, which both enhances cost-effectiveness and improves engagement, understanding and the validity of consent. Remaining uncertainties suggest that more research is needed before new communication modes are introduced into practice. Future research should measure the impact of the suggested practice changes (informing in third trimester, information toolkits, changed role of midwife).Trial registrationCurrent Controlled Trials ISRCTN70227207.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 55. See the NIHR Journals Library website for further project information.

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“…23,24 To date, the literature concerning consent and newborn screening has generally focused on attitudes toward consent policy. 7,[25][26][27][28][29] Although this is revealing, occasionally showing conflicting attitudes toward the need for consent, 6,30,31 there is a lack of descriptive research that depicts how the offer of NBS is made to parents, making it difficult to determine the experience of consent in practice. Understanding the experiences of those actually involved in the consent process may provide valuable descriptive information for NBS programs and providers.…”

Section: Introductionmentioning

confidence: 99%

Consent for newborn screening: parents’ and health-care professionals’ experiences of consent in practice

et al. 2016

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Consent processes for newborn bloodspot screening (NBS) are variable, with a lack of descriptive research that depicts how the offer of NBS is made to parents. We explored the experience, in practice, of consent for NBS. Semistructured interviews in two Canadian provinces were held with: (1) parents of children offered NBS (n = 32); and (2) health-care professionals involved in the NBS process (n = 19). Data on recollections of NBS, including consent processes, were utilized to identify emerging themes using the method of constant comparison. Three themes were relevant to NBS consent: (1) The 'offer' of NBS; (2) content and timing of information provision; and (3) the importance of parental experiences for consent decisions. Recollections of consent for NBS were similar between jurisdictions. Excepting midwives and their patients, NBS was viewed as a routine part of giving birth, with little evidence of an informed consent process. Although most parents were satisfied, all respondents suggested information about NBS be provided long before the birth. Accounts of parents who declined screening highlight the influence of parental experiences with the heel prick process in screening decisions. Findings further our understanding of consent in practice and highlight areas for improvement in parent-provider interactions.

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Parental Attitudes toward Ethical and Social Issues Surrounding the Expansion of Newborn Screening Using New Technologies

Cited by 53 publications

References 75 publications

Interest in Newborn Genetic Testing: A Survey of Prospective Parents and the General Public

Interest in Newborn Genetic Testing: A Survey of Prospective Parents and the General Public

Provision of information about newborn screening antenatally: a sequential exploratory mixed-methods project

Consent for newborn screening: parents’ and health-care professionals’ experiences of consent in practice

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