• An investigation into pregnant women's knowledge of prenatal screening: Implications for service provision

      Makowiecka, Krystyna; Lee, Diane L. (University of Liverpool (Chester College of Higher Education), 1997-11)
      Informed consent is one of the legal-ethical cornerstones of our health care system and is central to health care decision making. The ability of clients to make informed choices regarding their care is dependent upon the information imparted to them by health professionals, and also upon the client's subsequent understanding of such information. The issue of informed consent in relation to prenatal screening can be problematised because it requires consideration of complex moral and ethical issues, and the ability of clients to make informed choices is dependent upon the attitudes, knowledge base and communication skills of the health professionals who offer screening. In order to discover how much pregnant women know about prenatal screening tests, a cross-sectional survey using structured interviews was undertaken with a cohort of two hundred pregnant women who were offered prenatal screening. The knowledge possessed by each individual regarding maternal serum screening for Down's syndrome and ultrasound scan for fetal anomaly, was measured and subsequently analysed to ascertain if there was any relationship with their age, social class, parity and whether counselling was received by a hospital or community midwife. The scores obtained resulting from the knowledge possessed by each individual regarding both tests were further subject to statistical analysis to assess if participants were more knowledgeable regarding either the practical aspects or the implications of testing. Data regarding how each test was offered was also collected. Furthermore, participants cited the health professional whom they considered to have given the most useful information, and these data were analysed to assess if this had influenced the clients' knowledge base. The study concludes that pregnant women in this study are significantly more knowledgeable about maternal serum screening, than they are in relation to ultrasound scan. The levels of knowledge regarding both tests are significantly higher in the older age group and the professional group, suggesting that age and social class are strong demographic indicators of knowledge. Furthermore, participants are significantly better informed regarding the practical aspects of screening and demonstrate a lack of understanding regarding the more complex implications of screening. The source cited as having provided the most useful information (midwife, doctor, media or family and friends), is not an indicator of knowledge. It also appears that greater efforts are being made to present information on maternal serum screening to clients, indeed many participants failed to receive any verbal or written information regarding ultrasound scan. In order to facilitate and enable pregnant women to make informed choices regarding prenatal screening, it is proposed that they possess an understanding of both the practical aspects and the potential implications of being tested. Recommendations are made, which include the employment of a health professional whose specialist role would involve the co-ordination and monitoring of screening programmes. Furthermore effective staff training must address the individual and psychological needs of both staff and clients in respect of the complex and sensitive issues that accompany screening. Moreover, in order to guide health professionals in their clinical practice, a sound understanding of the ethical principles which underpin screening procedures is indicated.