Jane Kidd

Presenting a routine screening test in antenatal care: Practice observed

Peoples knowledge of screening tests for which they are eligible and which they may have undergone is frequently low. The aim of the current study is to determine the extent to which this is due to how a test is offered and explained. Routine consultations (n = 102) between midwives, obstetricians and pregnant women were tape-recorded to determine how a routine screening test for fetal abnormalities (maternal serum alpha-fetoprotein) is presented. The test was presented in the vast majority of consultations. Overall, little information was provided about the test, the conditions screened for, and the meaning of either a positive or a negative result. Screening was presented in such a way as to encourage women to undergo the test. The way in which routine prenatal screening is presented is unlikely to maximise informed decisions about whether to participate in this screening programme. Factors likely to be influencing test presentation include knowledge, attitudes and skills of staff, as well as the attitudes of pregnant women. The results of this study highlight a need to train the heath professionals implementing screening programmes in how to inform people fully about low probability but serious events without alarming them unduly, or reassuring them falsely.

Perceived risk not actual risk predicts uptake of amniocentesis

Summary. A consecutive cohort of 71 women eligible for amniocentesis because they were over 38 years of age completed questionnaires during the first trimester of pregnancy. Sixty‐one women underwent amniocentesis, an uptake rate of 86%. Uptake was associated with a less negative attitude towards termination of an affected baby and a higher perceived risk of the fetus being abnormal. It was not associated with actual age‐related risks. There was no significant relation between actual risk and perceived risk. The results of this study suggests that it is important for doctors to understand the basis of womens decisions to have amniocentesis, and the difference between actual and perceived risk if they are to communicate effectively with women about the test and their options.

The impact of prenatal screening and diagnostic testing upon the cognitions, emotions and behaviour of pregnant women

The purpose of most screening and diagnostic tests is to initiate treatment when a problem is found and, otherwise, to allay anxiety. The extent to which the second of these objectives is met was studied in a prospective study of 179 pregnant women. Women who had amniocentesis to detect Downs Syndrome or were screened for a fetal neural tube defect had significantly lower anxiety levels in the third trimester of pregnancy than women who did not undergo these tests. Undergoing screening for a neural tube defect was also associated with a more positive attitude towards the pregnancy in the second trimester. These results suggest that the previously reported raised levels of anxiety in women undergoing such tests do not necessarily remain high for the duration of the pregnancy and, indeed, undergoing testing may serve to protect women against high levels of anxiety in the third trimester of pregnancy.

Psychological models in predicting uptake of prenatal screening.

Abstract The purpose of the current study was to determine which psychological models are most useful in predicting uptake of a prenatal screening test, maternal-serum alphafetoprotein screening for spina bifida and Downs syndrome. 1000 women eligible for the test completed standardised self-report questionnaires at two routine clinic visits to an antenatal clinic prior to the time when the test could take place. 902 underwent the screening test; 51 declined the test; and 47 did not undergo the test, giving no reason for this to staff. Knowledge of the test, the subjective expected utility attached to the test, and attitudes to doctors and medicine were all significant predictors of uptake behaviour. Results of a discriminant function analysis demonstrated distinct psychological processes underlying each of these three uptake behaviours, explaining 21% of the variance in uptake of screening. If uptake of screening is examined not as a dichotomous variable but as a group of behaviours, predictive models a...

PSYCHOLOGICAL EFFECTS OF HAVING AMNIOCENTESIS: ARE THESE DUE TO THE PROCEDURE, THE RISK OR THE BEHAVIOUR?

The purpose of the study was to examine the impact of amniocentesis on women at risk for having a baby with Downs syndrome because of raised maternal age. Fifty-four of the study participants had amniocentesis and nine did not. At the time of the procedure, those having amniocentesis were significantly more anxious, less certain about the babys health, and held more negative attitudes towards the baby than women who did not undergo amniocentesis. For women undergoing amniocentesis there was a positive association between perceived risk of having an abnormal baby and anxiety. After the babys birth, women who had undergone amniocentesis held less positive attitudes to the baby and were significantly more worried about the babys health. These results suggest that the anxiety surrounding amniocentesis is related both to the procedure and to the perceived likelihood of an abnormal result. The differences between the groups after the birth seem more likely to reflect pre-existing attitudinal differences between the two groups, than the effects of amniocentesis.

Is routine AFP screening in pregnancy reassuring

Abstract The purpose of the study is to examine the impact of a negative result on a routine prenatal screening test, maternal serum alpha-fetoprotein screening for spina bifida and Downs syndrome. Three-hundred and nine women had the test and 30 did not. Twenty-one of the 309 did not think that they had been tested, and seven women who did not have the test thought that they had been tested. There were no significant differences between these four groups in anxiety, certainty about the babys health or worry about the babys health. These results suggest that the receipt of a negative result on this screening test does not provide reassurance. There are several possible explanations for this finding: the test is reassuring, but only for a small number of those undergoing the test; the test is reassuring but the study nethod was inappropriate and hence failed to detect it; the test is not reassuring because of a lack of knowledge about the meaning of a negative result or, the way in which results of testing are conveyed. The latter two explanations suggest that the potentially reassuring effects of such a result may be realised with more effective communication about test results.

Predicting Antenatal Class Attendance: Attitudes Of Self And Others

Attendance at antenatal classes has been found to improve birth outcomes, yet many women do not attend. This study investigates the extent to which we can predict attendance and whether womens expectations of classes are confirmed by their subsequent experiences. Intention to attend was the most predictive variable in the 529 primigravidas women studied. It was best predicted by womens general attitudes about coping and the value of attendance, rather than by specific expectations of classes. Womens perceptions of the attitudes of the babys father and of the hospital doctor were also important. Although there were demographic differences between attenders and non-attenders, they were less predictive than attitudes. These findings are consistent with the Theory of Reasoned Action. Womens experiences of classes were much more positive than their expectations. Giving this information to women and their partners may change their attitudes and, hence, attendance.

Is Routine AFP Screening in Pregnancy Reassuring

The purpose of the study is to examine the impact of a negative result on a routine prenatal screening test, maternal serum alpha-fetoprotein screening for spina bifida and Downs syndrome. Three-hundred and nine women had the test and 30 did not. Twenty-one of the 309 did not think that they had been tested, and seven women who did not have the test thought that they had been tested. There were no significant differences between these four groups in anxiety, certainty about the babys health or worry about the babys health. These results suggest that the receipt of a negative result on this screening test does not provide reassurance. There are several possible explanations for this finding: the test is reassuring, but only for a small number of those undergoing the test; the test is reassuring but the study method was inappropriate and hence failed to detect it; the test is not reassuring because of a lack of knowledge about the meaning of a negative result or, the way in which results of testing are conveyed. The latter two explanations suggest that the potentially reassuring effects of such a result may be realised with more effective communication about test results.