Abstract
Little has been reported regarding how women make decisions about genetic carrier screening for Ashkenazi Jewish genetic disease and cystic fibrosis (CF), and for fluorescent in situ hybridization (FISH) during pregnancy. Thirty-seven women who underwent genetic counseling and prenatal diagnosis were interviewed about their prenatal decision making. Respondents were largely Caucasian (95%), and undergoing prenatal diagnosis because of maternal age (78%). Sixty-three percent of those who reported having genetic carrier screening correctly defined it; 83% felt positively about it. Primary reasons reported for electing screening were: to get information, to be prepared, perception of risk, wanting peace of mind and percieved inability to care for an affected child. Women who declined screening felt they had very little or no risk, and some were deterred by cost. Ninety-five percent of respondents elected to have FISH; most were motivated by its speed in providing information and peace of mind or by timing of when the procedure was performed. Those who declined FISH reported being less concerned about having an affected child, receiving bad news, or waiting 2 weeks for results and slightly less affected by their “feelings toward medical testing” or physician's suggestion. These findings suggest decision-making factors differ between those electing and declining adjunct prenatal testing and increased knowledge about these factors may impact the way in which these services are offered by health care professionals. Prospective research with a larger population will be useful in further delineating the factors that influence prenatal decisions about adjunct testing measures.
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References
American College of Medical Genetics (ACMG) (1998). Position statement on carrier testing for Canavan disease. Bethesda, MD: Author.
American College of Obstetrics and Gynecology (ACOG) (1995). Screening for Tay Sachs disease: No. 162. Washington, DC.
American College of Obstetrics and Gynecology (ACOG) (2001a). Genetic screening for hemoglobinopathies no. 238, July 2000. Int J Gynecol Obstet, 74, 309-310.
American College of Obstetrics and Gynecology (ACOG) and American College of Medical Genetics (ACMG)(2001b). Preconception and prenatal carrier screening for cystic fibrosis: Clinical and laboratory guidelines. Washington, DC.
American Society for Reproductive Medicine (ASRM) (1998). Patient fact sheet: Genetic screening for birth defects. Birmingham, AL.
Browner, C., Preloran, H., & Simon, J. (1999). Ethnicity, bioethics, and prenatal diagnosis: The amniocentesis decisions of Mexican-origin women and their partners. Am J Public Health, 89(11), 1658-1666
Ekwo, E., Seals, B., Kim, J., Williamson, R., & Hanson, J. (1985). Factors influencing maternal estimates of genetic risk. Am J Med Genet, 20, 491-504.
Green, J. (1994). Serum screening for Down's syndrome: The experiences of obstetricians in England and Wales. BMJ, 309, 769-772.
Kohut, R., Dewey, D., & Love, E. (2002). Women's knowledge of prenatal ultrasound and informed choice. J Genet Couns, 11(4), 265-276.
Lesser, Y., & Rabinowitz, J. (2001). Elective amniocentesis in low-risk pregnancies: Decision making in the era of information and uncertainty. Am J Public Health, 91(4), 639-641.
Leung, W., Chitayat, D., Seaward, G., Windrim, R., Ryan, G., Barrett, J., et al. (2001). Role of amniotic fluid interphase fluorescence in situ hybridization (FISH) analysis in patient management. Prenat Diagn, 21, 327-332.
Marini, T., Sullivan, J., & Naeem, R. (2002). Decisions about amniocentesis by advanced maternal age patients following maternal serum screening may not always correlate clinically with screening results: Need for improvement in informed consent process. Am J Med Genet, 109, 171-175.
Marteau, T., & Croyle, R. (1998). The new genetics: Psychological responses to genetic testing. BMJ, 316(7132), 693-696.
Marteau, T., & Dormandy, E. (2001). Facilitating informed choice in prenatal testing: How well are we doing? Am J Med Genet, 106, 185-190.
Michie, S., Smith, D., & Marteau, T. (1999). Prenatal tests: How are women deciding? Prenat Diagn, 19, 743-748.
Miedzybrodzka, Z., Hall, M., Mollison, J., Templeton, A., Russell, I., Dean, J., et al. (1995). Antenatal screening for carriers of cystic fibrosis: Randomised trial of stepwise versus couple screening. BMJ, 310(6976), 353-357.
Pergament, E., Chen, P., Thangavelu, M., & Fiddler, M. (2000). The clinical application of interphase FISH in prenatal diagnosis. Prenat Diagn, 20, 215-220.
Santalahti, P., Aro, A., Hemminki, E., Helenius, H., & Ryynanen, M. (1998). On what grounds do women participate in prenatal screening? Prenat Diagn, 18, 153-165.
Shiloh, S., Eini, N., Ben-Neria, Z., & Sagi, M. (2001). Framing of prenatal screening test results and women's health-illness orientations as determinants of perceptions of fetal health and approval of amniocentesis. Psychol Health, 16, 313-325.
Shiloh, S., & Sagi, M. (1989). Effect of framing on the perception of genetic recurrence risks. Am J Med Genet, 33, 130-135.
Smith, D., & Marteau, T. (1995). Detecting fetal abnormality: Serum screening and fetal anomaly scans. Br J Midwif, 3, 133-136.
Tucker, A. (1997). The efficacy of FISH analysis for common aneuploidies in relieving the anxiety of patients awaiting prenatal diagnosis results. Master Degree Thesis, Northwestern University.
Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453-458.
Van Overwalle, F., & Jordens, K. (2002). An adaptive connectionist model of cognitive dissonance. Pers Soc Psychol Rev, 6(3), 204-231.
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Sturm, E.L., Ormond, K.E. Adjunct Prenatal Testing: Patient Decisions Regarding Ethnic Carrier Screening and Fluorescence In Situ Hybridization. Journal of Genetic Counseling 13, 45–63 (2004). https://doi.org/10.1023/B:JOGC.0000013194.53410.6f
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DOI: https://doi.org/10.1023/B:JOGC.0000013194.53410.6f