Document Detail

Risk and uncertainty: Shifting decision making for aneuploidy screening to the first trimester of pregnancy.
MedLine Citation:
PMID:  21293275     Owner:  NLM     Status:  Publisher    
PURPOSE:: The clinical introduction of first trimester aneuploidy screening uniquely challenges the informed consent process for both patients and providers. This study investigated key aspects of the decision-making process for this new form of prenatal genetic screening. METHODS:: Qualitative data were collected by nine focus groups that comprised women of different reproductive histories (N = 46 participants). Discussions explored themes regarding patient decision making for first trimester aneuploidy screening. Sessions were audio recorded, transcribed, coded, and analyzed to identify themes. RESULTS:: Multiple levels of uncertainty characterize the decision-making process for first trimester aneuploidy screening. Baseline levels of uncertainty existed for participants in the context of an early pregnancy and the debate about the benefit of fetal genetic testing in general. Additional sources of uncertainty during the decision-making process were generated from weighing the advantages and disadvantages of initiating screening in the first trimester as opposed to waiting until the second. Questions of the quality and quantity of information and the perceived benefit of earlier access to fetal information were leading themes. Barriers to access prenatal care in early pregnancy presented participants with additional concerns about the ability to make informed decisions about prenatal genetic testing. CONCLUSIONS:: The option of the first trimester aneuploidy screening test in early pregnancy generates decision-making uncertainty that can interfere with the informed consent process. Mechanisms must be developed to facilitate informed decision making for this new form of prenatal genetic screening.
Ruth M Farrell; Natasha Dolgin; Susan A Flocke; Victoria Winbush; Mary Beth Mercer; Christian Simon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-2
Journal Detail:
Title:  Genetics in medicine : official journal of the American College of Medical Genetics     Volume:  -     ISSN:  1530-0366     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815831     Medline TA:  Genet Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the 1Department of Bioethics and Obstetrics and Gynecology, Cleveland Clinic, Case Western Reserve University at Cleveland Clinic Lerner College of Medicine; 2Department of Bioethics, Cleveland Clinic; 3Department of Family Medicine, Case Western Reserve University; 4Cleveland State University, Cleveland, Ohio; and 5Department of Internal Medicine, Program in Bioethics and Medical Humanities, University of Iowa, Iowa City, Iowa.
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