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Counselling a pregnant woman about prenatal tests

Explore the evolution of prenatal tests, doctor's responsibilities, and implications for counseling pregnant women with clarity, transparency, and a patient-centered approach. Gain insights on decision-making, risk-balancing, and breaking difficult news effectively.

larrymitchell
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Counselling a pregnant woman about prenatal tests

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  1. - Masterclass 25th EBCOG Congress / Antalya / 19th May 2017 Counselling a pregnant woman about prenatal tests Sibil Tschudin / Switzerland

  2. The Pregnant Woman and her Child to be In former times: Wishes, hopes, fears Inner dialog, exclusive relationship

  3. The Pregnant Woman and her Child to be Nowadays: Knowledge, „objective“ images, diagnoses A „trialog“ dominated by medical terms

  4. Prenatal Tests Chorion villi sampling Amniocentesis Ultrasound NIPT 2000 1970 1980 1990 2010 1960 1950 2020 First trimester risk assessment AFPplus

  5. Prenatal Tests Pregnant woman

  6. the pregnant woman’s agenda • Confirmation that the child is healthy • The best for her child • Options to choose • Information – preparation • The opportunity to decide and act according to her attitudes and values Pregnant woman

  7. Prenatal Tests Pregnant woman Options Oportunity to decide Doctor

  8. The doctor’s tasks To detect fetal malformations To treat a fetal disease if possible medical Not to oversee a malformation juridical To reduce fears To provide security psychological Doctor

  9. Prenatal Tests Pregnant woman Options Options to decide Doctor Tasks Responsibility

  10. Peculiarities of Prenatal Tests Two-persons‘ system Mother-child-unit No direct involvement of the fetus  mother as representative

  11. Peculiarities of Prenatal Tests  AC / CVS implies a small but potentially fatal risk for the fetus Test results might be vague with regard to significance and prognosis „therapeutic“ options include killing the fetus(induced abortion)

  12. Implications for counselling How much information? Right of ignorance! Do not disturb Principles of biomedical ethics!

  13. Implications for counselling Health professionals’ attitude:  Authenticity  Congruence  Transparency

  14. Implications for counselling Patient-centred communication Provide space and time to express: - targets -needs -fears - values Perceive and appreciate emotional reactions

  15. Implications for counselling Communicative competencies: *Rogers, 1979 *Miller and Rollnick, 2002

  16. The Counselling Steps Clarifying Informing  Balancing  Deciding

  17. Clarifying Expectations ? Do not disturb Mandate

  18. Informing What? Options / limitations  Significance (risk vs. diagnosis) How? Elicit (need of) information Provide information in simple words Elicit understanding and significance  structured insmall units byannouncing the gist with summaries  with check backs

  19. Balancing Individual risk Individual benefit

  20. 1:10 Mio 1:1 Mio 1:100.000 1:10.000 1:100 1:10 1:1.000 very low zero minimal low moderate high Risk balancing Death by traffic accident Child with malformation Breast cancer at age 70y Child with Down‘s syndrome Infected wound

  21. Information about Probabilities / Risks Speak about probabilities, not about risks Mention not only the negative, but also the positive outcomes Absolute numbers in stead of percents Identical reference figures Give absolute numbers, absolute risks, avoid relative risks Use visual aids (graphs, drawings)

  22. Visual Aids Risk for Trisomy 21 at 11-14 weeks of pregnany

  23. Visual Aids

  24. Deciding Decision making  Knowledge  Experience  Emotions

  25. Type of Decision individual evaluation Evidence-based decision evidence preference sensitive decision evidence individual evaluation

  26. Difficult Decisions The pregnant woman  is overwhelmed and unable to make a decision delegates the decision to the doctor  is unable to decide, because the pros and cons balance each other  has a personality disorder

  27. Positive Test Result Breaking bad news!

  28. S-P-I-K-E-S Buckman R. Breaking bad news: The S-P-I-K-E-S strategy. Psychological Oncology, 2005.

  29. N-U-R-S-E Back et al. 2007

  30. Further information

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