Psychological issues in antenatal screening and testing 2012

Author: H. Skirton
Submitted: Tuesday 26th of June 2012 02:45:28 PM
Submitted by: egf
Language: English
Content type: Learning resource
Educational levels: expert, qc2, qc3

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Abstract

The term screening applies to the application of a test or tests in a general population in which most individuals will be considered at low risk.1 Screening is used as a method of identifying those in the population whose risk might be significantly high to warrant the offer of further diagnostic tests. The term genetic testing implies a more definitive result and it is usually carried out when there is reason to believe the fetus is at higher than population risk of a disorder. Samples for genetic testing in pregnancy may be taken using amniocentesis or chorionic villus biopsy.The Council of Europe recommendations for antenatal genetic screening and testing note that although there has been progress in detecting congenital conditions, these developments are accompanied by fears that they could have an adverse impact on societal perceptions of people with a disability3. Its recommendations are underpinned by a respect for human life and personal freedom and a commitment to the provision of appropriate information and education. It states that appropriate genetic counselling should accompany the offer of testing, and that the woman should be free from coercion to comply with screening or testing. The principles of antenatal screening3 require that screening is accompanied by: • Availability of pre and post test counselling • Nondirective counselling • Involvement of both partners, if possible • Informed consent • Equal opportunities for incapacitated persons to utilise screening and testing • Information that is sufficient to enable person to make informed decision • Pre-conceptual counselling if risks are known prior to the pregnancy. These principles are of course equally applicable in genetic testing situations. Screening and testing for congenital abnormalities should be offered in a way that is ethically acceptable and facilitates free choice. The presentation will include results of previous studies related to: i) How the offer of screening is made, ii) The knowledge of professionals offering screening iii) Maternal attitudes to and knowledge of screening and iv) Parental satisfaction with informed choice. Adults of reproductive age may be completely unprepared to make decisions about antenatal screening4. The potential effects of genetic testing and/or screening include interruption of bonding between parents and fetus, conflict between parents, ambiguous emotions and difficult decision making5,6. These will be discussed in the presentation. In addition, the impact of the introduction of non-invasive prenatal diagnostic (NIPD) methods on parental decision-making will be discussed7,8. References : 1. Skirton H, Patch C. Genetics for the Health Sciences. Oxford, SCION, 2009. 2. Public Health Genetics Unit. http://www.phgu.org.uk/info_database/diseases/downs_syndrome/downs.html 2005. [Accessed 23 June 2005] 3. Council of Europe. Council of Europe, Committee of Ministers, Recommendation No. R (90) 13 on Prenatal Genetic Screening, Prenatal Genetic Diagnosis and Associated Genetic Counselling (June 21, 1990), http://www1.umm.edu/humanrts/instree/coerecr90-13.html [Accessed 10 June 2005] 4. Skirton H, Murakami K, Ito M, Nakagomi S, Iino H (2008) A report of two linked studies of knowledge and attitudes to prenatal screening and testing in adults of reproductive age in Japan and the UK. Midwifery. 24(3):270-80. 5. Skirton H, Barr O. (2007) Influences on uptake of antenatal screening for Down syndrome: a review of the literature. Evidence Based Midwifery 5(1): 4-9. 6. Skirton H, Barr O. (2009) Antenatal screening and informed choice: a cross-sectional survey of parents and professionals. Midwifery. 2009 Feb 26. [Epub ahead of print] 7. Hill M, Compton C, Lewis C, Skirton H, Chitty L. (in press) Non-invasive prenatal diagnosis for fetal sex determination - benefits and disadvantages from the service users' perspective. Accepted for publication in the European Journal of Human Genetics. 8. Hill M, Compton C, Lewis C, Skirton H, Chitty L. (2011) Determination of fetal sex in pregnancies at risk of haemophilia: a qualitative study exploring the clinical practices and attitudes of health professionals in the United Kingdom. Haemophilia, doi: 10.1111/j.1365-2516.2011.02653.x. [Epub ahead of print]

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abstract Skirton_Psychological_issues_in_antenatal_screening_5196.pdf

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H. Skirton. Psychological issues in antenatal screening and testing 2012. EUROGENE portal. June 2012. online: http://eurogene.open.ac.uk/content/psychological-issues-antenatal-screening-and-testing-2012

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