the Order of Genetic Counseling and Ultrasound In the Second Trimester For Patients Screen Positive Down Syndrome: Effects On Patient Knowledge, Anxiety, Decision-Making, and Satisfaction
The American College of Obstetricians and Gynecologists (ACOG) recommends women whose prenatal screening results indicate an increased risk for fetal aneuploidy be offered a detailed ultrasound exam, diagnostic testing, and genetic counseling as follow-up to their positive screening result (ACOG Committee on Practice Bulletins, 2007). The current study examined if the relative order of genetic counseling and ultrasound has an effect on a patient's decision-making process regarding diagnostic testing by measuring the following outcomes: state anxiety, knowledge, decisional conflict, and satisfaction. Respondents were recruited from patients who were referred to University of South Carolina's Specialty Clinic, Department of Obstetrics and Gynecology with an indication of screen positive Down syndrome and were scheduled on the same day for ultrasound and genetic counseling with the option of amniocentesis. Respondents in Group A (n = 14) had ultrasound prior to genetic counseling, while those in Group B (n = 19) had genetic counseling prior to ultrasound. State anxiety, knowledge, and decisional conflict were measured at three times during their visit: initially, after the ultrasound, and following genetic counseling. Patient satisfaction was measured at the end of the visit. Statistical analysis of the total results (N = 33) from the beginning to end indicated a decrease in state anxiety (n = 28, p < .001) and decisional conflict (n = 26, p < .001), an increase in patient knowledge (n = 29, p < .001), and high satisfaction at the end (n = 30). Neither the demographics nor the outcomes measured were significantly different between the two groups. Although our results suggest the relative order of genetic counseling and ultrasound during the follow-up for women with an indication of SPDS may not impact the decision-making process regarding amniocentesis, practical trends consistent with previous studies were identified including ultrasound has the greater effect of decreasing state anxiety and genetic counseling has the greater effect of increasing patient knowledge.
Genetics and Genomics, Life Sciences, anxiety, decision-making, follow-up, maternal serum screening, screen positive Down syndrome, second trimester
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