Yesterday’s post shared how the Department of Defense/Veterans Administration guidelines recognize the need for genetic counseling when offering prenatal testing. One of the methods was group counseling, in which the guidelines said participants learned best as compared to individual counseling or decision aids. What do participants choose then, that have learned best through group counseling?
At the Madigan Army Medical Center, genetic counselors conducted a study of over 400 patients. About 75% of the participants received individual counseling and 25% participated in group counseling sessions. Here’s what the counselors found:
- Before counseling, both groups had about the same level of knowledge about prenatal testing and Down syndrome, meaning they answered questions correctly and incorrectly about the same.
- As should be expected, both groups reported significant increases in knowledge after counseling, answering a higher percentage of questions correctly.
- Those who participated in group counseling had a higher percentage of correct answers than those just receiving individual counseling.
- And, those who received group counseling were less likely to accept prenatal screening.
That may seem paradoxical and counter-intuitive: if the patients understood screening testing, what its results meant, and what Down syndrome is, then why did fewer accept the testing? Perhaps it’s because the patients understood screening testing, what its results meant, and what Down syndrome is.
The authors are conscientious in noting the parameters of their study. This was a study done at a military hospital where the mean age of patients was 25, with only 7% being 35 or older. The younger population of patients may inform the reduced rate of accepting prenatal testing, as the probability of having a child with Down syndrome is lower than for women over the age of 35, and, therefore, may not be considered as significant of a concern by younger moms.
Finally, the authors further note that this study was carried out before the introduction of non-invasive prenatal screening (NIPS). Regarding the newest form of testing, the authors offer:
With the use of [NIPS], many patient will be receiving an almost definitive diagnosis for certain aneuploidy disorders in the first trimester of pregnancy. This has raised many ethical considerations including how to deliver this kind of information to patients who have likely been given only minimal information through their primary obstetrician. The need to provide appropriate pre-test counseling and informed consent from women considering this test is of the utmost importance and should emulate the counseling provided to patients considering diagnostic procedures such as CVS and amniocentesis.With more knowledge about prenatal screening, this study found fewer women accepted it. But, the opportunity to raise patients understanding about prenatal screening and Down syndrome will likely be reduced with non-invasive prenatal screening. The need for pre-test counseling recognized by the DoD/VA and demonstrated by the results of this study therefore is justified even more in this new age of prenatal genetic testing.