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Identifying Strategies to Improve Shared Decision Making for Pregnant Patients' Decisions about Prenatal Genetic Screens and Diagnostic Tests.
Collart, Christina; Craighead, Caitlin; Yao, Meng; Chien, Edward K; Rose, Susannah; Frankel, Richard M; Coleridge, Marissa; Hu, Bo; Edmonds, Brownsyne Tucker; Ranzini, Angela C; Farrell, Ruth M.
Afiliación
  • Collart C; Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Craighead C; Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Yao M; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
  • Chien EK; Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Rose S; Experience Safety, Quality and Patient Experience, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA.
  • Frankel RM; Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA.
  • Coleridge M; Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Hu B; Genomic Medicine Institute, Cleveland Clinic, Cleveland OH, USA.
  • Edmonds BT; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
  • Ranzini AC; Indiana University School of Medicine, Indiana University, Indianapolis IN, USA.
  • Farrell RM; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA.
Med Decis Making ; 44(6): 689-704, 2024 08.
Article en En | MEDLINE | ID: mdl-39082665
ABSTRACT

PURPOSE:

Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions.

METHODS:

We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions.

RESULTS:

Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3).

CONCLUSION:

Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients' informed decision making about these options. Importantly, patients' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication. HIGHLIGHTS Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients' ability to make informed decisions about prenatal genetic tests in early pregnancy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diagnóstico Prenatal / Pruebas Genéticas / Toma de Decisiones Conjunta Límite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Med Decis Making Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diagnóstico Prenatal / Pruebas Genéticas / Toma de Decisiones Conjunta Límite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Med Decis Making Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos