A randomized trial comparing alternative approaches to prenatal diagnosis counseling in advanced maternal age patients

Abstract

Prenatal diagnosis (PND) is offered routinely as part of pregnancy care to a large number of women at increased risk of fetal anomalies. Despite an extraordinary growth in the use of PND and significant resource allocation, few studies have examined outcomes of PND counseling, and virtually no research has evaluated the relative efficacy of various approaches to genetic counseling. This study was a randomized trial that compared which counseling methods - individual, group, and use of a decision aid - are effective in PND counseling for women of advanced maternal age (>/=35 years) and their partners. Three hundred and fifty-two women and 225 partners completed pre- and post-intervention questionnaires assessing changes in knowledge, decisional conflict, state anxiety, satisfaction, use of PND, and pregnancy outcomes. All participants showed a significant increase in knowledge and a decrease in decisional conflict post intervention. Those in the group intervention showed a significantly greater increase in knowledge than those in the individual counseling intervention. While high levels of satisfaction were reported by all, those in individual counseling were significantly more satisfied than those receiving group counseling or the decision aid. This study has shown unique benefits with each type of intervention such that women and their partners preferred individual genetic counseling, while they learned best in group-counseling sessions, and experienced the least decisional conflict regarding genetic testing with a decision aid.

The effect of a decision aid on informed decision-making in the era of non-invasive prenatal testing: a randomised controlled trial

“…[12][13][14]21 Other studies evaluating the effect of patient decision aids on decisionmaking regarding prenatal testing for fetal chromosomal abnormalities have been published. Previous studies have reported on the application of booklets with worksheets, 22,23 information films, 24,25 and interactive computer programmes. [26][27][28] Although results from these studies cannot easily be compared because of heterogeneity in settings, interventions and outcome measures, most have general findings that correspond with the results of the present study.…”

“…[26][27][28] Although results from these studies cannot easily be compared because of heterogeneity in settings, interventions and outcome measures, most have general findings that correspond with the results of the present study. Nearly all found the application of a decision aid to increase pregnant women's decision-relevant knowledge [22][23][24][25][26][27] and informed decision-making. 23,25 In this trial, high baseline levels of informed decision-making in the control group notwithstanding the application of the web-based multimedia decision aid resulted in an increase in informed decision-making that was slightly higher than the effect found in previous evaluations.…”

Attitudes of women of advanced maternal age undergoing invasive prenatal diagnosis and the impact of genetic counselling

“…This is in line with the results of a randomized trial comparing different prenatal counselling methods, which showed that women and their partners preferred individual genetic counselling, while learned best in group counselling sessions. 13 Therefore, none of the two approaches has proven superior to the other one in relation to the parameters analysed; in addition, both approaches have been suggested to be similarly effective in identifying risk factors beyond AMA in a previous study, 12 thus leading to the conclusion that either one can be adopted.…”

“…Nevertheless, evidence on the outcomes, as well as on the optimal approach of genetic counselling preceding IPP is extremely scarce. 13 In recent years, at the Academic Hospital Policlinico S.OrsolaMalpighi, women of AMA undergoing IPP at the Unit of Obstetrics, have been receiving pre-test genetic counselling from the staff of the Medical Genetics Unit. Counselling approach has changed over time because of organization reasons: at first (from January 2010 to June 2011), women/couples used to undergo individual counselling sessions, whereas since July 2011, counselling has been offered in the form of group sessions.…”

A Randomized Trial of a Prenatal Genetic Testing Interactive Computerized Information Aid

“…[10][11][12][13] Use of decision aids for prenatal counseling using structured, paper-based or basic electronic tools has been associated with less decision conflict, improved knowledge, and in some cases, increased uptake of prenatal testing. [14][15][16][17][18] Such tools can facilitate an improved informed consent process, yet few decision aids have been developed and evaluated in the United States, particularly for use in low literacy populations. 11 In 2009, Kuppermann et al showed that use of an interactive prenatal diagnostic decision tool resulted in better patient satisfaction, more decision certainty, and more accurate estimates of risk among women receiving prenatal genetic counseling.…”