Abstract
Objective: To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing. Setting: A regional genetics center. Design: A before/after study. Interventions: Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions. Subjects: 21 women of advanced maternal age and 17 spouses. Main outcome measures: Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid. Results: After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid. Conclusions: The decision aid shows promise as a useful aid for preparing couples for counseling.
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REFERENCES
Ajzen I, Fishbein M (1980) Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice Hall.
Barry MJ, Fowler FJ, Mulley AG, Henderson JV, Wennberg JE (1995) Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Med Care 33:771-782.
Bunn H, O'Connor AM (1996) Validation of client decision making instruments in the context of psychiatry Can J Nur Res 28:13-27.
Burke BM, Kolker A (1994) Directiveness in prenatal genetic counseling. Women's Health 22:31-53.
Canadian College of Medical Geneticists and the Society of Obstetricians and Gynaecologists of Canada (1993) Canadian guidelines for prenatal diagnosis of genetic disorders: An update. J Soc Obstet Gynaecol Can (March Suppl.):15-39.
Canadian Task Force on the Periodic Health Examination (1994) The Canadian Guide to Clinical Preventive Health Care. Ottawa, ON: Health Canada.
Clarke A, Parsons E, Williams A (1996) Outcomes and process in genetic counseling. Clin Genet 50:462-469.
Feather NT (1980) Expectations and Actions: Expectancy-Value Models in Psychology. Hillsdale, NJ: L. Erlbaum.
Goel V, Glazier R, Holzapfel S, Pugh P, Summers A (1996) Evaluating patient's knowledge of maternal serum screening. Prenat Diag 16:425-430.
Goel V, Glazier R, Summers A, Holzapfel S (1998) Psychological outcomes following maternal serum screening: A cohort study. Can Med Assoc J 159:651-656.
Hook EB, Cross PK, Schreinemachers DM (1983) Chromosomal abnormality rates at amniocentesis and in live-born infants. JAMA 249:2034-2038.
Hunter AG, Thompson D, Speevak M (1987) Midtrimester genetic amniocentesis in eastern Ontario: A review from 1970 to 1985. J Med Genet 24:335-343.
Janis IL, Mann L (1979) Decision making: A Psychological Analysis of Conflict, Choice and Commitment. New York: Free Press.
Kasper JF, Mulley AG, Wennberg JE (1992) Developing shared decision making programs to improve the quality of health care. Qual Rev Bull June:183-190.
Keeney RL, Raiffa H (1976) Decisions with Multiple Objectives: Preferences and Tradeoffs, Toronto, ON: Wiley.
Laupacis A (1996) Preventive therapies: Pros and cons. Can Med Assoc J 154:1510-1512.
Levine MN, Gafni A, Markham B, MacFarlane D (1992) A bedside decision instrument to elicit a patient's preferences concerning adjuvant chemotherapy for breast cancer. Ann Intern Med 117:53-58.
Michie S, Marteau T (1996) Genetic counselling: Some issues of theory and practice. In Marteau T, Richards M (eds) The Troubled Helix: Social and Psychological Implications of the New Human Genetics. Cambridge: Cambridge University Press., pp. 104-122.
O'Connor AM (1995) Validation of a decisional conflict scale. Medical Decision Making 15:25-30.
O'Connor AM, Tugwell P, Wells G, Elmslie T, Jolly E, Hollingworth G, McPherson R, Drake ER, Hopman W, Mackenzie T (1998a) A decision aid for women considering hormone therapy after menopause: Decision support framework and evaluation. Patient Education and Counseling 33:267-279.
O'Connor AM, Tugwell P, Wells G, Elmslie T, Jolly E, Hollingworth G, McPherson R, Drake ER, Hopman W, Mackenzie T (1998b) Randomized trial of a portable, self-administered decision aid for post-menopausal women considering long term preventive hormone therapy. Medical Decision Making 18:295-303.
Pauker SP, Pauker SG (1987) The amniocentesis decision: Ten years of decision analytic experience. Birth Defects 23:151-169.
Pitz GF (1987) Evaluating decision-aiding technologies for genetic counseling. Birth Defects: Original Article Series 23:251-278.
Rothert M, Holmes-Rovner M, Rovner D, Kroll J, Breer L, Talarczyk G, Schmitt N, Padonu G, Wills C (1997) An educational intervention as decision support for menopausal women. Research in Nursing and Health 20:377-387.
Spielberger CD, Gorsuch RL, Luschene RE, Vagg PR, Jacobs GA (1983) Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologists Press.
Statistics Canada (1998) Census '96 Statistical Profile: Education Statistics for Ottawa, Ontario [Table]. Retrieved February 16, 1999, from the World Wide Web http//ww2.statcan.ca/english/profil/.
Thornton JG (1999) Parents' decision making about prenatal testing: The effect of giving information in different ways (Cochrane Review Protocol). In: The Cochrane Library, Issue 2. Oxford: Update Software.
Thornton JG, Hewison J, Lilford RJ, Vail A (1995) A randomised trial of three methods of giving information about prenatal testing. Br Med J 311:1127-1130.
Tri-Council Working Group (1996) Code of Conduct for Research Involving Humans (draft). Ottawa, ON: Medical Research Council of Canada, Social Sciences and Humanities Research Council and the Natural Sciences and Engineering Research Council of Canada.
Tversky A, Kahneman D (1981) The framing of decisions and the psychology of choice. Science 211:453-458.
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Drake, E.R., Engler-Todd, L., O'Connor, A.M. et al. Development and Evaluation of a Decision Aid About Prenatal Testing for Women of Advanced Maternal Age. Journal of Genetic Counseling 8, 217–233 (1999). https://doi.org/10.1023/A:1022998415890
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DOI: https://doi.org/10.1023/A:1022998415890