Τόμος 21 (2007) – Τεύχος 1 – Άρθρο 10 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Διεθνής Έκδοση – Volume 21 (2007) – Issue 1 – Article 10 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-International Edition

Title The concept of informed choice in health: case of prenatal screening for Down syndrome
Author Kleanthi Gourounti

Department of Midwifery, School for Professions of Health and Welfare, Technological Educational Institution of Athens, Greece

Citation Gourounti, K.: The concept of informed choice in health: case of prenatal screening for Down syndrome, Epitheorese Klin. Farmakol. Farmakokinet. 21(1): 67-74 (2007)
Publication Date Accepted for publication (Final version): 15 January 2007
Full Text Language English
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Keywords Informed choice, informed decision making, prenatal screening, Down syndrome.
Other Terms review article
Summary Several of choices in maternity, such as antenatal screening for Down syndrome, have important implications for women and thus informed choice has fundamental importance. The choice to undergo screening for Down syndrome should be based on a full understanding of the likely benefits, harms and limitations of screening. Many definitions have been given for informed choice but all these definitions have two core characteristics: a) relevant, good quality information and b) consistency between attitudes and behaviour. An informed decision could be defined as a reasoned choice which is made by a reasonable individual using relevant information about the advantages and disadvantages of all possible courses of action in accord with the individuals belief. The conclusions that have been drawn from this literature review concern mainly the measurement, the determinants and the factors that may impact on informed choice. Regarding the measurement of informed choice, it could be concluded that there is a lack of standardized measures that assess the multidimensionality of informed choice because often measures of informed choice are ether single dimensioned measures or measures of self report. Concerning the knowledge which is one of the determinants of the informed choice, has been concluded that: a) level of knowledge adequate for informed decision making have not achieved, b) women’s knowledge is influenced by the way of presentation of information and by the knowledge of healthcare professional, c) a considerable amount of given information concerning the results of screening is not easily understandable by women because of the numerical approach of information and thus d) knowledge is not the same as understanding. It has been also concluded that the professional recommendation concerning the given information about screening for Down syndrome may be inadequate because they don’t include information about the condition of Down syndrome. Health care professionals (midwives and obstetricians) should dedicate more time to discussing with women and should provide information which is understandable and suitable to their learning ability. Moreover, concerning the women’s attitude which is another determinant of informed choice could be concluded that attitude is a stronger determinant of informed choice than knowledge since many women who stated that the received information from health professional was useful and adequate didn’t make an informed choice finally. Therefore, the tempt to increase attitude-behavior consistency could be more successful in increasing informed choice in screening for Down syndrome than increasing the level of knowledge.
References 1.    Charles C., Whelan T., Gafni A.: What do we mean by partnership in making decisions about treatment? Br. Med. J. 319: 780-782 (1999)

2.    Emanuel E., Emanuel L.: Four models of the physician-patient relationship. JAMA 267: 2221-2226 (1992)

3.    Brown J., Kitson A., Mcknight T.: Challenges in Caring. Chapman and Hal, London, 1992

4.    Marteau T., Dormandy E., Crockett R.: Informed choice: why measuring behaviour is important. Arch. Dis. Child 90: 546 (2005)

5.    Bekker H., Thornton J., Aire M., et al.: Informed decision making: an annotated bibliography and systematic review. Health Technol. Assess. 3: 1 (1999)

6.    O’ Connor A.: Decisional conflict In: Nursing Diagnosis and Intervention: Planning for patient care (McFarland G. and McFarlane E. eds). Mosby, 1997

7.    Marteau T., Dormandy E., Michie S.: A measure of informed choice. Health Expectations 4: 99-108 (2001)

8.    Kirkham M.: Informed choice in maternity care. Palgrave Macmillan, 2004

9.    Green J., Coupland V.: Great expectations: a prospective study of women’s expectations and experiences of childbirth. Centre for Family Research, Cambridge 1988; 2

10.  Sharpino M., Najman J., Chang A., Keeping J., Morrison J., et al.: Information control and the exercise of power in the obstetrical encounter. Soc. Sci. Med. 17: 139-146 (1983)

11.  Fawsett J., Burritt J.: An exploratory study of antenatal preparation for caserean birth. J. Obstet. Gynaecol. Neonat Nursing 14: 224-230 (1985)

12.  Entwistle V., Sheldon T., Sowden A., et al.: Evidence-informed patient choice. Intern. J. Technol. Assess. Health Care 14: 215-225 (1998)

13.  Department of Health: Changing Childbirth. Report of the Expert Maternity Group. HMSO, London, 1993

14.  Midwives Information and Resource Service (MIDIRS). Informed Choice Leaflets [online] available: www.infochoice.org. [accessed 25.6.05]

15.  Churchil H., Benbow A.: Informed choice in maternity services. Br J. Midwifery 8: 41-47 (2000)

16.  Wyke S., Hewison J., Elton R., et al.: Does general practitioner involvement in commissioning maternity care make a difference? J. Health Serv. Res. Policy 6: 99-104 (2001)

17.  O’ Cathain A., Thomas K., Walters S., Nicholl J., Kirkham M.: Women’s perceptions of informed choice in maternity care. Midwifery 18: 136-144 (2002)

18.  Levy V.: Mainting equilibrium: a grounded theory study of the process involved when women make informed choices during pregnancy. Midwifery 15: 109-119 (1999)

19.  Petticrew M., Sowden A., Lister-Sharp D., Wright K.: False-negative results in screening programmes: a systematic review of impact and implications. Health Technol. Assess. 4(5): (2000)

20.  Emery J.: Is informed choice in genetic testing a different breed of informed decision making? A discussion paper. Health Expect. 4: 81-86 (2001)

21.  Jepson R., Forbes C., Sowden A., Lewis R.: Increasing informed uptake and non-uptake of screening: evidence from a systematic review. Health Expect 4: 116-130 (2001)

22.  Green J., Hewison J., Bekker H., Bryant L., Cuckle H.: Psychological aspects of genetic screening of pregnant women and newborns: a systematic review. Health Technol. Assess. 8 (33) (2004)

23.  Raffle A.: Information about screening- is it to achieve high uptake or to ensure informed choice? Health Expectations 4: 92-98 (2001)

24.  Kirkham M. and Stapleton. Informed Choice in Maternity Care: An Evaluation of Evidence Based Leaflets. York NHS Centre for Reviews and Dissemination, 2001

25.  Berger K.: Informed choice: information or knowledge? Med. Law 22: 743-750 (2003)

26.  Miller S., Mangan C.: Interacting effects of information and copying style in adapting to gynaecologic stress: should the doctor tell all? J. Personal Social Psychol. 45: 223-236 (1983)

27.  Royal College of Obstetricians and Gynaecologists. Report of the RCOG Working Party on Biochemical markers and the Detection of Down’s syndrome, London, RCOG, 1993

28.  Royal College of Obstetricians and Gynaecologists and Royal College of Paediatrics and Child Health. Fetal abnormalities: Guidelines for screening, diagnosis and management. London RCOG and RCPCH, 1997

29.  General Medical Council. Seeking patients’ consent: the ethical considerations. London, 1999

30.  Bryant L.D., Murray J., Green J.M., Hewison J., Sehmi I., Ellis A.: Descriptive information about Down syndrome: a content analysis of serum screening leaflets. Prenat. Diagn. 21: 1057-1063 (2001)

31.  Chilaka V., Konje J., Stewart C., Narayan H., Taylor D.: Knowledge of Down syndrome in pregnant women from different ethnic groups. Prenat. Diagn. 21: 159-164 (2001)

32.  Mulvey S., Wallace E.: Women’s knowledge and attitudes to first and second trimester screening for Down’s syndrome. Br. J. Obstet. Gynaecol. 107: 1302-1305 (2000)

33.  Gigerenzer G., Edwards A.: Simple tools for understanding risks: from innumeracy to insight. Br. Med. J. 327: 741-744 (2003)

34.  Edwards A., Elwyn G., Mulley A.: Explaining risks: turning numerical data into meaningful pictures. Br. Med. J. 324: 827-324 (2002)

35.  Mazur D., Mertz J.: Patients’ interpretation of verbal expressions of probability – implications for securing informed consent to medical interventions. Behav. Sci. Law 12: 417-426 (1994)

36.  Etore E.: Reproductive genetics, gender and the body: ‘please doctor, may I have a normal baby’. Sociology 34: 403-420 (2000)

37.  Pilnick A., Fraser D., James D.: Presenting and discussing nuchal translucency screening for fetal abnormality in UK. Midwifery 20: 82-93 (2004)

38.  Godolphin W.: The role of risk communication in shared decision making. Br. Med. J. 327: 692-693 (2003)

39.  Gourounti K., Lykeridou K.: The risk in public: health. Rev. Clin. Pharmacol. Pharmacokinet. 19: 93-97 (2005)

40.  Donegan K. Framing, cognitive modes, and image theory: toward an understanding of a glass half full. J. Appl. Psychol. 78: 491-503 (1993)

41.  Michie S., Smith D., Marteau T.: Prenatal tests: how are women deciding? Prenatal Diagn. 19: 743-748 (1999)

42.  Michie S., Smith D., McClennan A., Marteau T.: Patient decision making: an evaluation of two different methods of presenting information about a screening test. Br. J. Health Psychol. 2: 317-326 (1997)

43.  Graham W., Smith P., Kamal A., Fitzmaurice A., Smith N., Hamilton N.: Randomized controlled trial comparing effectiveness of touch screen system with leaflet for providing women with information on prenatal tests. Br. Med. J. 320: 155-160 (2000)

44.  Thornton J., Hewison J., Lilford R., Vail A.: A randomized trial of three methods of giving information about prenatal testing. Br Med. J. 311: 1127-1130 (1995)

45.  Browner C., Preloran M., Press N.: The effects of ethnicity, education and an information video on pregnant women’s knowledge and decision about a prenatal diagnostic screening test. Patient Educ. Counsel. 27: 135-146 (1996)

46.  Hewi son J., Cuckle H., Baillie C., Sehmi I., Lindow S. et al.: Use of videotapes for viewing at home to inform choice in Down syndrome screening: a randomized controlled trial. Prenat. Diagn. 21: 146-149 (2001)

47.  Freda M., DeVore N., Valenti neAdams N., Bombard A., Merkatz I. Informed consent for maternal serum alphaphetoprotein screening in an inner city population: how informed is it? J. Obstetr. Gynecol. Neonat. Nursing 27: 99-106 (1998)

48.  Grewal G.K., Moss H.J., Aitken D.A., Bjornsson S., Cameron A.D., Pel J.P.: Factors affecting women’s knowledge of antenatal serum screening. Scott. Med. J. 42(4): 111-113 (1997)

49.  Gourounti K., Kourtis P., Lykeridou K., Katostaras T., Antsaklis A.: The pregnant women’s knowledge and experiences of ultrasound screening in the first trimester. J. Maternal-Fetal Neonat. Med. XIX European Congress of Perinatal Medicine. Abstracts of oral presentations, Athens, 10/2004

50.  Pantazis K., Athanasiadis A., Togaridou E., Diakogiannis I., Karavida K., Dinas K., Mpontis J.: Expectations and feelings of women who present for second trimester level II ultrasound scan. Ultrasonography 2: 49-53 (2005)

51.  Ajzen I., Fishbein M.: Understanding Attitudes and Predicting Social Behaviour. Englwood Cliffs, Prentice Hal, New Jersey, 1980

52.  Ajzen I.: Attitudes, Personality and Behaviour. Open University Press, Bristol, 1988

53.  Moyer A., Brown B., Gates E., Daniels M., Brown H., Kuppermann M.: Decisions about prenatal testing for chromosomal disorders: perceptions of a diverse group of pregnant women. J. Womens Health Gend. Based Med. 8: 521-531 (1999)

54.  Michie S., Dormandy E., Marteau T. Informed choice : understanding knowledge in the context of screening uptake. Patient Educ. Counsel. 50: 247-253 (2003)

55.  Conner M., Norman P.: Predicting Health Behaviour. Open University Press, Buckingham, 1996

56.  Dormandy E., Michie S., Hooper R., Marteau T.: Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women’s attitudes or a failure to facilitate informed choices? Intern. J. Epidemiol. 34: 346-352 (2005)

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