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Artal JM, Randall L, Rubeck S, Allyse M, Michie M, Riggan KA, Meredith S, Skotko BG. Parents of children with Down syndrome reflect on their postnatal diagnoses, 2003-2022. Am J Med Genet A 2024; 194:e63619. [PMID: 38619097 DOI: 10.1002/ajmg.a.63619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
A 2003 survey revealed the scope of mothers' dissatisfaction with their postnatal support following a diagnosis of Down syndrome (DS). Substantial proportions of mothers reported that providers conveyed diagnoses with pity, emphasized negative aspects of DS, and neglected to provide adequate materials explaining DS. This study follows up on the 2003 survey by assessing whether parents' experiences have improved. Four DS nonprofit organizations, which participated in the original study, distributed a mixed-methods survey to families who have had children with DS between 2003 and 2022. Quantitative analysis assessed correlations among responses and differences between the 2003 and 2022 survey groups. Open-ended responses were qualitatively analyzed. Compared to the 2003 findings, parents' perceptions of their postnatal care have not improved (N = 89). Parents are increasingly likely to report that their providers pitied them, omitted positive aspects of DS, and provided insufficient materials describing DS. Substantial proportions of parents reported fear (77%) and anxiety (79%), only 24% described receiving adequate explanatory materials, and parents were 45% likelier to report that physicians discussed negative aspects of DS than positive aspects. Qualitatively, substantial numbers of parents recounted insensitive conduct by providers. These results suggest that despite interventions, parents' experiences of postnatal diagnoses of DS have not improved over time. Certain provider behaviors-such as describing positive aspects of DS and providing comprehensive explanatory materials-can reduce fear and anxiety, pointing to directions for reform.
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Affiliation(s)
- Jonathan M Artal
- Stanford Law School, Stanford University, Stanford, California, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lindsey Randall
- The Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Sabina Rubeck
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, Florida, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Marsha Michie
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephanie Meredith
- Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Ijaz MR, Trepanier AM, Kleinert HL, Weiss SM, Meredith SH. Parent-reported genetic counselor adherence to the NSGC practice resource for communicating a potential prenatal diagnosis: Impact on the Down syndrome diagnosis experience. J Genet Couns 2024. [PMID: 39031948 DOI: 10.1002/jgc4.1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/13/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
In 2011, the National Society of Genetic Counselors (NSGC) published practice resources about communicating a prenatal or postnatal diagnosis of Down syndrome (DS). However, the impact of GC adherence to those recommendations on patient experiences has been unknown. The objective of this analysis was to investigate perceived GC adherence to professional recommendations for delivering a DS diagnosis and the impact on parental diagnosis experiences and the information and support offered. Parents of children with DS born between 2016 and 2021 completed a survey distributed by 12 local DS organizations and the national DS Diagnosis Network to assess prenatal diagnosis experiences and the provision of support and information by health professionals. Participants were queried about whether their GC followed specific recommendations from the NSGC practice resource. Respondents were also invited to describe their diagnosis experience. An overall perceived adherence score was calculated (percentage of elements GC demonstrated/total number of elements). Open-ended responses were inductively coded by a GC and GC student to identify categories and to perform a sentiment analysis where 1 was completely negative, 2 was mixed/more negative, 3 was neutral, 4 was mixed/more positive, and 5 was completely positive. The GCs were blinded to participants' perceived adherence scores while performing the sentiment analysis. Of the 242 parents who completed the survey, 161 respondents answered questions about GC's perceived practice resource adherence. The median perceived adherence score was 42.9% (IQR 21.4-71.4)%. A total of 61 people provided an open-ended response about their prenatal diagnosis experience with a GC and were assigned a sentiment score. The median sentiment score was 3 (IQR 1-5). Kendall's Tau analysis showed that higher perceived practice resource adherence was associated with more positive sentiment scores. These results suggest that NSGC practice resource adherence may improve the prenatal diagnosis experiences of parents of children with DS and have the potential to improve counseling outcomes.
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Affiliation(s)
- Maryam R Ijaz
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Angela M Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Harold L Kleinert
- Lettercase National Center for Prenatal and Postnatal Resources, Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Sierra M Weiss
- Lettercase National Center for Prenatal and Postnatal Resources, Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Stephanie H Meredith
- Lettercase National Center for Prenatal and Postnatal Resources, Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
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Craig KP, Riggan KA, Rubeck S, Meredith SH, Allyse MA, Michie M. Never "totally prepared": Support groups on helping families prepare for a child with a genetic condition. J Community Genet 2023:10.1007/s12687-023-00646-y. [PMID: 37046173 PMCID: PMC10092915 DOI: 10.1007/s12687-023-00646-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
A rapid increase in the reach and breadth of prenatal genetic screening and testing has led to an expanding need for prenatal support of families receiving this genetic information. As part of a larger study investigating prenatal preparation for a child with a genetic condition, we interviewed representatives of patient advocacy groups (PAGs) who support parents post-diagnosis. Groups supporting families with Down syndrome were often local or regional, while other groups were often national or international in scope. Groups varied in their willingness or ability to support families prior to making a pregnancy continuation decision, and participants reflected on ways they addressed these needs with individual counseling and referrals, if needed. Participants described supporting parents with information about conditions and a range of lived experiences for families, while referring families to healthcare professionals for technical questions and additional medical needs. PAGs also prioritized connecting parents experiencing a new diagnosis with other families for peer support and community-building, both in person and on social media. Participants discussed limitations, such as a lack of racially-concordant support, ability to offer resources in languages other than English, and a lack of funding to meet the expressed needs of families post-diagnosis. Overall, participants emphasized that the parenting experience of each child is unique, irrespective of a genetic diagnosis, an experience for which parents can never be "totally prepared."
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Affiliation(s)
- Kaitlynn P Craig
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Sabina Rubeck
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stephanie H Meredith
- Lettercase National Center for Prenatal and Postnatal Resources, University of Kentucky's Human Development Institute, Lexington, KY, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program & Department of Obstetrics & Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Timing of Referrals to a Down Syndrome Parent Group by Race. Pediatr Qual Saf 2023; 8:e632. [PMID: 36798110 PMCID: PMC9925096 DOI: 10.1097/pq9.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
The Down Syndrome Association of Central Ohio (DSACO) is a nonprofit organization that supports families, promotes community involvement, and encourages lifetime opportunities for people with Down syndrome. Methods At DSACO, ongoing efforts for quality improvement included: a Medical Advisory Committee in 2016, the creation of resources groups for Latino families in 2017, for Somali families from 2018 to 2019, and for African American families in fall 2018, presentations at birth hospitals, and close tracking of referrals from hospitals when an infant with Down syndrome is born. In addition, the timing of referrals, either "early" (on the day of birth or the first day after birth) or "late" (2 or more days after birth), were tracked and plotted in p charts. Results From January 2017 to April 2021, DSACO received 167 referrals; of these, a median of 65% was received "early." When analyzing all referrals to DSACO, no special cause was seen over the time studied. When evaluating the timing of referral to DSACO by race, referrals for 78% of White families were early (105/135 referrals). In comparison, referrals for 9% of minority families were early (3/32 referrals). Conclusions The timing of DSACO referral differed by race. Outreach efforts did not change referral timing but led to a more diverse DSACO membership. Future study is needed to confirm if there is racial disparity in the timing of referrals to resources nationally and to understand the barriers in referring diverse families to Down syndrome nonprofit organizations.
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Vanasse AM, Weiler T, Roth EA, Upadhya S, Toriello HV, VanLeuven AJ, Norris JR, Carey JC, Sobering AK. Teaching perspectives on the communication of difficult news of genetic conditions to medical students. Am J Med Genet A 2023; 191:299-305. [PMID: 36286987 PMCID: PMC10092636 DOI: 10.1002/ajmg.a.63003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/23/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
Informing parents that their child has a diagnosis of Down syndrome (DS) is a common example of the delivery of unexpected or difficult news. Expectations and life planning will change, and if detected prenatally, discussions might include the option of pregnancy termination. Medical school curricula currently include training in breaking unexpected news; however, it is difficult to teach and assess. We use the perspectives of clinicians, educators, and a medical student who is the parent of a child with DS to frame a discussion on teaching, practicing, and assessing communication of difficult news in human genetics during medical school.
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Affiliation(s)
- Ashley M Vanasse
- Department of Biochemistry, St. George's University, St. George's, Grenada.,Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
| | - Tracey Weiler
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Elizabeth A Roth
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - Sharmila Upadhya
- Department of Biochemistry, St. George's University, St. George's, Grenada
| | - Helga V Toriello
- Department of Pediatrics and Human Development, Michigan State University - College of Human Medicine, East Lansing, Michigan, USA
| | - Ariel J VanLeuven
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John R Norris
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University, St. George's, Grenada.,AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
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Recommendations to Improve the Patient Experience and Avoid Bias When Prenatal Screening/Testing. Disabil Health J 2022; 16:101401. [PMID: 36463093 DOI: 10.1016/j.dhjo.2022.101401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
While prenatal screening and testing have expanded substantially over the past decade and provide access to more genetic information, expectant parents are more likely to describe the diagnosis experience as negative than positive. In addition, the conversations that take place during these experiences sometimes reflect unconscious bias against people with disabilities. Consequently, an interdisciplinary committee of experts, including people with disabilities, family members, disability organization leaders, healthcare and genetics professionals, and bioethicists, reviewed selected published and gray literature comparing the current state of the administration of prenatal testing to the ideal state. Subsequently, the interdisciplinary team created recommendations for clinicians, public health agencies, medical organizations, federal agencies, and other stakeholders involved with administering prenatal screening and testing to create better patient experiences; conduct training for healthcare professionals; create, enforce, and fund policies and guidelines; and engage in more robust data collection and research efforts.
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