Effect of Shared Decision-making on Anxiety of Women Recommended for Prenatal Screening Tests in Southeast of Iran
Objective: To study the effect of shared decision-making (SDM) on the anxiety of women who were recommended for prenatal screening tests.
Materials and methods: This quasi-experimental study was conducted on a total of 200 pregnant women who referred to the health centers of Zahedan, Iran, for prenatal care within April 7 to September 7, 2019. The control group received routine care, and the intervention group attended a session based on SDM. The demographic characteristics form and Spielberger Six-item State-Trait Anxiety Inventory were filled out before and immediately after the counseling, as well as before receiving the results of maternal serum biochemical markers.
Results: No statistically significant effect of SDM on anxiety was reported between the control and intervention groups immediately after the counseling session (P=0.46). However, the obtained data showed that the mean value of anxiety scores (16.52±3.06) was higher among the women in the intervention group than that reported for the control group (13.80±3.55) on the day before receiving the results of the blood tests (P<0.001). Nevertheless, logistic regression analysis showed only women with a university level of education were likely to have higher anxiety scores than women with lower educational levels (AOR=10.60; 95% CI: 2.07-54.24; P=0.005).
Conclusion: Offering prenatal screening can cause a slight increase in the level of anxiety among women with a university level of education. Therefore, it is required to implement supportive strategies to help high-risk pregnant women in coping with anxiety.
2. Kleinveld JH, Timmermans DR, de Smit DJ, Ader HJ, van der Wal G, ten Kate LP. Does prenatal screening influence anxiety levels of pregnant womens? a longitudinal randomised controlled trial. Prenat Diagn 2006; 26: 354-61.
3. Driscoll DA, Gross SJ. First trimester diagnosis and screening for fetal aneuploidy. Genet Med 2008; 10: 73-5.
4. Health Quality Ontario. Noninvasive Prenatal Testing for Trisomies 21,18, and 13, sex Chromosome Aneuploidies, and Microdeletions: A Health Technology Assessment. Ont Health Technol Assess Ser 2019; 19: 1-166.
5. Rabiee M, Jouhari Z, Pirasteh A. Knowledge of Prenatal screening, Down syndrome, Amniocentesis, and Related Factors Among Iranian Pregnant Women: A Cross- Sectional Study. International Journal of Community Based Nursing and Midwifery 2019; 7: 150-60.
6. Cocciolone R, Brameld K, O'Leary P, Haan E, Muller P, Shand K. Combining first and second trimester markers for Down syndrome screening: think twice. Aust N Z J Obstet Gynaecol 2008; 48: 492-500.
7. Sánchez-Durán MÁ, Bernabeu Garcia A, Calero I, Ramis Fossas J, IIIescas T, Aviles MT, et al. Clinical application of a contingent screening strategy for trisomies with cell-free DNA:a pilot study. In: BMC Pregnancy Childbirth 2019; 19: 274.
8. Chandrasekharan S, Minear MA, Hung A, Allyse M. Noninvasive prenatal testing goes global. Sci Transl Med 2014; 6: 231fs15.
9. Lou S, Mikkelsen L, Hvidman L, Petersen OB, Nielsen CP. Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review. Acta Obstet
Gynecol Scand 2015; 94: 15-27.
10. Kaiser AS, Ferris LE, Pastuszak A, Llewellyn-Thomas H, Johnson JA, Conacher S, et al. The effects of prenatal group genetic counselling on knowledge, anxiety and decisional conflict: issues for nuchal transluency screening. J Obstet Gynaecol 2002; 22: 246–55.
11. Kowalcek I. Stress and anxiety associated with prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2007; 21: 221-8.
12. Biesecker BB. The psychological well-being of pregnant women undergoing prenatal testing and screening: a narrative literature review. Hastings Cent Rep 2019; 49 Suppl 1:S53-S60.
13. Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. In: J Clin Psychiatry 2018; 79: 17r12011.
14. Kowalcek I, Huber G, Lammers C, Brunk J, Bieniakiewicz I, Gembruch U. Anxiety scores before and after prenatal testing for congenital anomalies. Arch Gynecol Obstet 2003; 267: 126-9.
15. Zindler L. Ethical decision making in first trimester pregnancy screening. J Perinat Neonatal Nurs 2005; 19: 122-31.
16. Pop-Tudose ME, Popescu-Spineni D, Armean P, Pop IV. Attitude, Knowledge, and informed choice towards prenatal screening for Down syndrome: a cross-sectional study. In: BMC Pregnancy Childbirth 2018; 18: 439.
17. Bakst S, Romano-Zelekha O, Ostrovsky J, Shohat T. Determinants associated with making prenatal screening decision in a national study. J Obstet Gynaecol 2019; 39: 41-8.
18. Portocarrero MEL, GGiguere AMC, Lepine J, Garvelink MM, Robitaille H, Delanoe A, et al. Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say? In: BMC Pregnancy Childbirth 2017; 17: 90.
19. Grad R, Legare F, Bell NR, Dickinson JA, Singh H, Moore AE, et al. Shared decision making in preventive health care: what it is; what it is not. Can Fam Physician 2017; 63: 682-4.
20. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyad A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27: 1361-7.
21. Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making:multistage consultation process. BMJ 2017; 359: j4891.
22. Vlemmix F, Warendorf JK, Rosman AN, Kok M, Mol BWJ, Morris JM, et al. Decisional aids to improve informed decision-making in pregnancy care: a systematic review. BJOG 2013; 120: 257-66.
23. Hooker GW, Leventhal KG, DeMarco T, Peshkin BN, Finch C, Wahl E, et al. Longitudinal changes in patient distress following interactive decision aid use among BRCA1/2 carriers: a randomized trial. Med Decis Making 2011; 31: 412-21.
24. Waldron T, Carr T, McMullen L, Westhorp G, Duncan V, Neufeld SM, et al. Development of a program theory for shared decision-making: a realistic synthesis. In: BMC Health Serv Res 2020; 20: 59.
25. Evidence: helping people shared decision making. A review of evidence considering whether shared decision making is worthwhile. The Health Foundation 2012.
26. Makoul G, Clayman M. An integrative model of shared decision making in medical encounters. Patient Educ Couns 2006; 60: 301-12.
27. Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait anxiety inventory (STAI). Br J Clin Psychol 1992; 31: 301-6.
28. Court H, Greenland K, Margrain TH. Measuring Patient anxiety in primary care: rasch analysis of the 6-item Spilberger state anxiety scale. Value Health 2010; 13: 813-9.
29. Marteau TM, Bekker H. The development of a sixScoring_6item_STAI_shortform_Bekker2015.
30. Hewison J, Cuckle H, Baillie C, Sehmi I, Lindow S, Jackson F, et al. Use of videotapes for viewing at home to inform choice in Down syndrome screening: a randomised controlled trial. Prenat Diagn 2001; 21: 146-9.
31. Say R, Robson S, Thomson R. Helping pregnant women make better decisions: a systematic review of the benefits of patient decision aids in obstetrics. BMJ Open 2011; 1: e000261.
32. van den Berg M, Timmermans DR, Ten Kate LP, van Vugt JM, van der Wal G. Are pregnant women making informed choices about prenatal screening? Genet Med 2005; 7: 332-8.
33. Lou S, Nielsen CP, Hvidman L, Petersen OB, Risør MB. Coping with worry while waiting for diagnostic results: a qualitative study of the experiences of pregnant couples following a high-risk prenatal screening result. BMC Pregnancy Childbirth 2016; 16: 321.
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