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Education and Parental Involvement in Decision-Making About Newborn Screening: Understanding Goals to Clarify Content

  • Theory Based Paper
  • Published:
Journal of Genetic Counseling

Abstract

A challenge in designing effective education for parents about newborn screening (NBS) has been uncertainty about appropriate content. Arguing that the goals of education may be usefully tied to parental decision-making, we sought to: (1) explore how different ways of implementing NBS differ in their approaches to parental engagement in decision-making; (2) map the potential goals of education onto these “implementation models”; and (3) consider the content that may be needed to support these goals. The resulting conceptual framework supports the availability of comprehensive information about NBS for parents, irrespective of the model of implementation. This is largely because we argue that meeting parental expectations and preferences for communication is an important goal regardless of whether or notparents are actively involved in making a decision. Our analysis supports a flexible approach, in which some educational messages are emphasized as important for all parents to understand while others are made available depending on parents’ preferences. We have begun to define the content of NBS education for parents needed to support specific goals. Further research and discussion is important to determine the most appropriate strategies for delivering the tailored approach to education that emerged from our analysis.

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References

  • Alexander, D., & Van Dyck, P. C. (2006). A vision of the future of newborn screening. Pediatrics, 117(5), S350–S354.

    Article  Google Scholar 

  • American Academy of Pediatrics Newborn Screening Task Force. (2000). Serving the family from birth to the medical home. Newborn screening: a blueprint for the future. A call for a national agenda on state newborn screeningprograms. Pediatrics, 106(2 II), 389–427.

  • Araia, M. H., & Potter, B. K. (2011). Newborn screening education on the internet: a content analysis of North American newborn screening  program websites. Journal of Community Genetics, 2, 127–134.

    Article  Google Scholar 

  • Araia, M. H., Wilson, B. J., Chakraborty, P., Gall, K., Honeywell, C., Milburn, J., et al. (2012). Factors associated with knowledge of and satisfaction with newborn screening education: a survey of mothers. Genetics in Medicine, 14(12), 963–970.

    Article  Google Scholar 

  • Arnold, C. L., Davis, T. C., Frempong, J. O., Humiston, S. G., Bocchini, A., Kennen, E. M., et al. (2006). Assessment of NBS parent education materials. Pediatrics, 117(5), S320–S325.

    Article  Google Scholar 

  • Bombard, Y., Miller, F. A., Hayeems, R. Z., Carroll, J. C., Avard, D., Wilson, B. J., et al. (2012). Citizens’ values regarding research with stored samples from NBS in Canada. Pediatrics, 129(2), 239–247.

    Article  Google Scholar 

  • Botkin, J. R., Clayton, E. W., Fost, N. C., Burke, W., Murray, T. H., Baily, M. A., et al. (2006). NBS technology: proceed with caution. Pediatrics, 117(5), 1793–1799.

    Article  Google Scholar 

  • Botkin, J. R., Rothwell, E., Anderson, R., Stark, L., Goldenberg, A., Lewis, M., et al. (2012). Public attitudes regarding the use of residual NBS specimens for research. Pediatrics, 129(2), 231–238.

    Article  Google Scholar 

  • Clayton, E. W. (2005). Talking with parents before NBS. Journal of Pediatrics, 147(3 suppl), S26–S29.

    Article  Google Scholar 

  • Couzin-Frankel, J. (2009). New focus: science gold mine, ethical minefield. Science, 324(5924), 166–168.

    Article  CAS  Google Scholar 

  • Davis, T. C., Humiston, S. G., Arnold, C. L., Bocchini, J. A., Jr., Bass, P. F., III, Kennen, E. M., et al. (2006). Recommendations for effective NBS communication: results of focus groups with parents, providers, and experts. Pediatrics, 117(5), S326–S340.

    Article  Google Scholar 

  • Detmar, S., Hosli, E., Dijkstra, N., Nijsingh, N., Rijnders, M., & Verweij, M. (2007). Information and informed consent for neonatal screening: opinions and preferences of parents. Birth, 34(3), 238–244.

    Article  Google Scholar 

  • Dhondt, J. L. (2005). Implementation of informed consent for a cystic fibrosis NBS program in France: low refusal rates for optional testing. The Journal of Pediatrics, 147(3), S106–S108.

    Article  Google Scholar 

  • Entwistle, V. A., Carter, S. M., Trevena, L., Flitcroft, K., Irwig, L., McCaffery, K., et al. (2008). Communicating about screening. British Medical Journal, 337, a1591.

    Article  Google Scholar 

  • Fant, K. E., Clark, S. J., & Kemper, A. R. (2005). Completeness and complexity of information available to parents from newborn-screening programs. Pediatrics, 115(5), 1268–1272.

    Article  Google Scholar 

  • Foral, F. E. (2006). Necessity’s sharp pinch: parental and states’ rights in conflict in an era of newborn genetic screening. Journal of Health & Biomedical Law, 11(1), 109–128.

    Google Scholar 

  • Grosse, S. D., Boyle, C. A., Kenneson, A., Khoury, M. J., & Wilfond, B. S. (2006). From public health emergency to public health service: the implications of evolving criteria for NBS panels. Pediatrics, 117(3), 923–929.

    Article  Google Scholar 

  • Gurian, E. A., Kinnamon, D. D., Henry, J. J., & Waisbren, S. E. (2006). Expanded NBS for biochemical disorders: the effect of a false-positive result. Pediatrics, 117(6), 1915–1921.

    Article  Google Scholar 

  • Haga, S. B. (2010). Analysis of educational materials and destruction/opt-out initiatives for storage and use of residual NBS samples. Genetic Testing and Molecular Biomarkers, 14(5), 587–592.

    Article  Google Scholar 

  • Hargreaves, K., Stewart, R., & Oliver, S. (2005a). NBS information supports public health more than informed choice. Health Education Journal, 64(2), 110–119.

    Article  Google Scholar 

  • Hargreaves, K. M., Stewart, R. J., & Oliver, S. R. (2005b). Informed choice and public health screening for children: the case of blood spot screening. Health Expectations, 8(2), 161–171.

    Article  Google Scholar 

  • Hayeems, R. Z., Miller, F. A., Little, J., Carroll, J. C., Allanson, J., Chakraborty, P., et al. (2009). Informing parents about expanded NBS: influences on provider involvement. Pediatrics, 124, 950–958.

    Article  Google Scholar 

  • Hewlett, J., & Waisbren, S. E. (2006). A review of the psychosocial effects of false-positive results on parents and current communication practices in NBS. Journal of Inherited Metabolic Disease, 29(5), 677–682.

    Article  CAS  Google Scholar 

  • Howell, R. R. (2006). We need expanded NBS. Pediatrics, 117(5), 1800–1805.

    Article  Google Scholar 

  • Kai, J., Ulph, F., Cullinan, T., Qureshi, N (2009). Communication of carrier status information following universal NBS for sickle cell disorders and cystic fibrosis: qualitative study of experience and practice. Health Technology Assessment,13 (57).

  • Kemper, A. R., Fant, K. E., & Clark, S. J. (2005). Informing parents about NBS. Public Health Nursing, 22(4), 332–338.

    Article  Google Scholar 

  • Kerruish, N. J., Webster, D., & Dickson, N. (2008). Information and consent for NBS: practices and attitudes of service providers. Journal of Medical Ethics, 34(9), 648–652.

    Article  CAS  Google Scholar 

  • Knowles, M. S., Holten, E. F. I., & Swanson, R. A. (2005). The adult learner. The definitive classic in adult education and human resource development. 6th ed. Burlington: Elsevier.

    Google Scholar 

  • Laberge, C., Kharaboyan, L., & Avard, D. (2004). NBS, banking, and consent. GenEdit, 2(3), 1–15.

    Google Scholar 

  • Lewis, M. H., Goldenberg, A., Anderson, R., Rothwell, E., & Botkin, J. (2011). State laws regarding the retention and use of residual NBS blood samples. Pediatrics, 127(4), 703–712.

    Article  Google Scholar 

  • Liebl, B., Nennstiel-Ratzel, U., von, K. R., Fingerhut, R., Olgemoller, B., Zapf, A., et al. (2002). Very high compliance in an expanded MS-MS-based NBS program despite written parental consent. Preventive Medicine, 34(2), 127–131.

    Article  Google Scholar 

  • Loeber, J. G., Burgard, P., Cornel, M. C., Rigter, T., Weinreich, S. S., Rupp, K., et al. (2012). NBS programmes in europe; arguments and efforts regarding harmonization. part 1 - from blood spot to screening result. Journal of Inherited Metabolic Disease, 35(4), 603–611.

    Article  Google Scholar 

  • Mandl, K. D., Feit, S., Larson, C., & Kohane, I. S. (2002). NBS program practices in the united states: notification, research, and consent. Pediatrics, 109(2 I), 269–273.

    Article  Google Scholar 

  • Manson, N. C. (2010). Why do patients want information if not to take part in decision making? Journal of Medical Ethics, 36(12), 834–837.

    Article  Google Scholar 

  • Marteau, T. M., Dormandy, E., & Michie, S. (2001). A measure of informed choice. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 4(2), 99–108.

    Article  CAS  Google Scholar 

  • Miller, F. A., Hayeems, R. Z., Carroll, J. C., Wilson, B., Little, J., Allanson, J., et al. (2010). Consent for NBS: the attitudes of health care providers. Public Health Genomics, 13(3), 181–190.

    Article  CAS  Google Scholar 

  • Moody, L., & Choudhry, K. (2013). Parental views on informed consent for expanded NBS. Health Expectations, 16, 135–146.

    Article  Google Scholar 

  • Moyer, V. A., Calonge, N., Teutsch, S. M., & Botkin, J. R. (2008). Expanding NBS: process, policy, and priorities. Hastings Center Report, 38(3), 32–39.

    Article  Google Scholar 

  • Newborn screening: Toward a uniform screening panel and system. (2006). Genetics in Medicine, 8(Suppl 1), 1S–252S.

  • Newborn screening clearinghouse. Available: http://www.babysfirsttest.org. Accessed 30 September 2014.

  • Newson, A. (2006). Should parental refusals of NBS be respected? Cambridge Quarterly of Healthcare Ethics, 15(2), 135–146.

    Article  Google Scholar 

  • Nicholls, S. G. (2010). Knowledge or understanding informed choice in the context of newborn bloodspot screening. Public Health Ethics, 3(2), 128–136.

    Article  Google Scholar 

  • Nicholls, S. G. (2012). Proceduralisation, choice and parental reflections on decisions to accept newborn bloodspot screening. Journal of Medical Ethics, 38, 299–303.

    Article  Google Scholar 

  • Nijsingh, N. (2007). Informed consent and the expansion of NBS. In A. Dawson, & M. Verweij (Eds.), Ethics, prevention, and public health (pp. 198–212). UK: Oxford University Press.

  • O'Connor, A., & O'Brien-Pallas, L. L. (1989). Decisional conflict. In G. K. Mcfarlane & E. A. Mcfarlane (Eds.), Nursing diagnosis and intervention (pp. 486–496). Toronto: Mosby.

    Google Scholar 

  • Raffle, A. E. (2001). Information about screening - is it to achieve high uptake or to ensure informed choice? Health Expectations, 4(2), 92–98.

    Article  CAS  Google Scholar 

  • Ross, L. F. (2010). Mandatory versus voluntary consent for NBS? Kennedy Institute of Ethics Journal, 20(4), 299–328.

    Google Scholar 

  • Ross, L. F., Saal, H. M., David, K. L., Anderson, R. R., & the American Academy of Pediatrics, American College of Medical Genetics and Genomics. (2013). Technical report: ethical and policy issues in genetics testing and screening of children. Genetics in Medicine, 15(3), 234–245.

    Article  Google Scholar 

  • Stapleton, H., Kirkham, M., & Thomas, G. (2002). Qualitative study of evidence based leaflets in maternity care. British Medical Journal, 324(7338), 639–643.

    Article  Google Scholar 

  • Stewart, R., & Oliver, S. (2003). What is known about communication with parents about newborn bloodspot screening? (p. 2003). London: UK NBS Programme Centre.

    Google Scholar 

  • Stewart, R., Hargreaves, K., & Oliver, S. (2005). Evidence informed policy making for health communication. Health Education Journal, 64(2), 120–128.

    Article  Google Scholar 

  • The President’s Council on Bioethics. (2008). The changing moral focus of NBS: An ethical analysis by the President's Council on Bioethics. Washington: Author.

    Google Scholar 

  • Therrell, B. L., & Adams, J. (2007). NBS in North America. Journal of Inherited Metabolic Disease, 30(4), 447–465.

    Article  Google Scholar 

  • Therrell, B. L., Johnson, A., & Williams, D. (2006). Status of NBS programs in the United States. Pediatrics, 117(5), S212–S252.

    Article  Google Scholar 

  • Tluczek, A., Orland, K. M., Nick, S. W., & Brown, R. L. (2009). NBS: an appeal for improved parent education. The Journal of Perinatal & Neonatal Nursing, 23(4), 326–334.

    Article  Google Scholar 

  • Trinidad, S. B., Fullerton, S. M., Ludman, E. J., Jarvik, G. P., Larson, E. B., & Burke, W. (2011). Research practice and participant preferences: the growing gulf. Science, 331(6015), 287–288.

    Article  CAS  Google Scholar 

  • UK National Screening Committee. Programme appraisal criteria. Criteria for appraising the viability, effectiveness and appropriateness of a screening programme. Available: http://www.screening.nhs.uk/criteria (accessed February 20, 2014).

  • UK NBS Programme Centre (2012). Health Professional Handbook. Available: http://newbornbloodspot.screening.nhs.uk. (Accessed May 13, 2014).

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Conflict of Interest

Beth K Potter declares that she has no conflict of interest. Holly Etchegary declares that she has no conflict of interest. Stuart G Nicholls declares that he has no conflict of interest. Brenda J Wilson declares that she has no conflict of interest. Samantha M Craigie declares that she has no conflict of interest. Makda H Araia declares that she has no conflict of interest.

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Potter, B.K., Etchegary, H., Nicholls, S.G. et al. Education and Parental Involvement in Decision-Making About Newborn Screening: Understanding Goals to Clarify Content. J Genet Counsel 24, 400–408 (2015). https://doi.org/10.1007/s10897-014-9780-x

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  • DOI: https://doi.org/10.1007/s10897-014-9780-x

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