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Published in: Journal of Genetic Counseling 1/2018

01-02-2018 | Original Research

Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability

Authors: Talya Miron-Shatz, Sivan R. Rapaport, Naama Srebnik, Yaniv Hanoch, Jonina Rabinowitz, Glen M. Doniger, Linda Levi, Jonathan J. Rolison, Avi Tsafrir

Published in: Journal of Genetic Counseling | Issue 1/2018

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Abstract

Funding policy and medico-legal climate are part of physicians’ reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician’s assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N = 171) completed a questionnaire and provided amniocentesis recommendations for women at 18 weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger (‘yes’ regardless of testing results: 6.4%; ‘no’ regardless of testing results: 31.6%) versus older woman (‘yes’ regardless of testing results: 40.9%; ‘no’ regardless of testing results: 7.0%; χ2 = 71.55, p < .01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians’ recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician’s assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence.
Literature
go back to reference American College of Obstetricians & Gynecologists (ACOG). (2013). ACOG committee opinion no. 551: Coping with the stress of medical professional liability litigation. Obstetrics & Gynecology, 121(1), 220–222.CrossRef American College of Obstetricians & Gynecologists (ACOG). (2013). ACOG committee opinion no. 551: Coping with the stress of medical professional liability litigation. Obstetrics & Gynecology, 121(1), 220–222.CrossRef
go back to reference American College of Obstetricians & Gynecologists (ACOG). (2015). ACOG committee opinion no. 640: Cell-free DNA screening for fetal aneuploidy. Obstetrics & Gynecology, 126(3), 691–692.CrossRef American College of Obstetricians & Gynecologists (ACOG). (2015). ACOG committee opinion no. 640: Cell-free DNA screening for fetal aneuploidy. Obstetrics & Gynecology, 126(3), 691–692.CrossRef
go back to reference Buchanan, A., Sachs, A., Toler, T., & Tsipis, J. (2014). NIPT: Current utilization and implications for the future of prenatal genetic counseling. Prenatal Diagnosis, 34(9), 850–857. doi:10.1002/pd.4382.CrossRefPubMed Buchanan, A., Sachs, A., Toler, T., & Tsipis, J. (2014). NIPT: Current utilization and implications for the future of prenatal genetic counseling. Prenatal Diagnosis, 34(9), 850–857. doi:10.​1002/​pd.​4382.CrossRefPubMed
go back to reference Croskerry, P. (2015). Clinical decision making. In P. R. Barach, J. P. Jacobs, S. E. Lipshultz, & P. C. Laussen (Eds.), Pediatric and congenital cardiac care (pp. 397–410). New York: Springer. Croskerry, P. (2015). Clinical decision making. In P. R. Barach, J. P. Jacobs, S. E. Lipshultz, & P. C. Laussen (Eds.), Pediatric and congenital cardiac care (pp. 397–410). New York: Springer.
go back to reference Dixon, W. J., & Mood, A. M. (1946). The statistical sign test. Journal of the American Statistical Association, 41(236), 557–566.CrossRefPubMed Dixon, W. J., & Mood, A. M. (1946). The statistical sign test. Journal of the American Statistical Association, 41(236), 557–566.CrossRefPubMed
go back to reference Grinshpun-Cohen, J., Miron-Shatz, T., Berkenstet, M., & Pras, E. (2015). The limited effect of information on Israeli pregnant women at advanced maternal age who decide to undergo amniocentesis. Israel Journal of Health Policy Research, 4(1), 1. doi:10.1186/s13584-015-0019-6.CrossRef Grinshpun-Cohen, J., Miron-Shatz, T., Berkenstet, M., & Pras, E. (2015). The limited effect of information on Israeli pregnant women at advanced maternal age who decide to undergo amniocentesis. Israel Journal of Health Policy Research, 4(1), 1. doi:10.​1186/​s13584-015-0019-6.CrossRef
go back to reference Grinshpun-Cohen, J., Miron-Shatz, T., Ries-Levavi, L., & Pras, E. (2014). Factors that affect the decision to undergo amniocentesis in women with normal down syndrome screening results: It is all about the age. Health Expectations, 18(6), 2306–2317. doi:10.1111/hex.12200.CrossRefPubMed Grinshpun-Cohen, J., Miron-Shatz, T., Ries-Levavi, L., & Pras, E. (2014). Factors that affect the decision to undergo amniocentesis in women with normal down syndrome screening results: It is all about the age. Health Expectations, 18(6), 2306–2317. doi:10.​1111/​hex.​12200.CrossRefPubMed
go back to reference Gyselaers, W., Hulstaert, F., & Neyt, M. (2015). Contingent non-invasive prenatal testing: An opportunity to improve non-genetic aspects of fetal aneuploidy screening. Prenatal Diagnosis, 35(13), 1347–1352. doi:10.1002/pd.4704.CrossRefPubMed Gyselaers, W., Hulstaert, F., & Neyt, M. (2015). Contingent non-invasive prenatal testing: An opportunity to improve non-genetic aspects of fetal aneuploidy screening. Prenatal Diagnosis, 35(13), 1347–1352. doi:10.​1002/​pd.​4704.CrossRefPubMed
go back to reference Lesser, Y., & Rabinowitz, J. (2001). Elective amniocentesis in low-risk pregnancies: Decision making in the era of information and uncertainty. American Journal of Public Health, 91(4), 639–641.CrossRefPubMedPubMedCentral Lesser, Y., & Rabinowitz, J. (2001). Elective amniocentesis in low-risk pregnancies: Decision making in the era of information and uncertainty. American Journal of Public Health, 91(4), 639–641.CrossRefPubMedPubMedCentral
go back to reference McGovern, M. M., Benach, M., & Zinberg, R. (2003). Interaction of genetic counselors with molecular genetic testing laboratories: Implications for non-geneticist health care providers. American Journal of Medical Genetics, 119A(3), 297–301. doi:10.1002/ajmg.a.20196.CrossRefPubMed McGovern, M. M., Benach, M., & Zinberg, R. (2003). Interaction of genetic counselors with molecular genetic testing laboratories: Implications for non-geneticist health care providers. American Journal of Medical Genetics, 119A(3), 297–301. doi:10.​1002/​ajmg.​a.​20196.CrossRefPubMed
go back to reference Pergament, D., & Ilijic, K. (2014). The legal past, present and future of prenatal genetic testing: Professional liability and other legal challenges affecting patient access to services. Journal of Clinical Medicine, 3(4), 1437–1465. doi:10.3390/jcm3041437.CrossRefPubMedPubMedCentral Pergament, D., & Ilijic, K. (2014). The legal past, present and future of prenatal genetic testing: Professional liability and other legal challenges affecting patient access to services. Journal of Clinical Medicine, 3(4), 1437–1465. doi:10.​3390/​jcm3041437.CrossRefPubMedPubMedCentral
go back to reference Raffi, F., Shaw, R. W., & Amer, S. A. (2012). National survey of the current management of endometriomas in women undergoing assisted reproductive treatment. Human Reproduction, 27(9), 2712–2719. doi:10.1093/humrep/des195.CrossRefPubMed Raffi, F., Shaw, R. W., & Amer, S. A. (2012). National survey of the current management of endometriomas in women undergoing assisted reproductive treatment. Human Reproduction, 27(9), 2712–2719. doi:10.​1093/​humrep/​des195.CrossRefPubMed
go back to reference Rossignol, M., Moutquin, J., Boughrassa, F., Bédard, M., Chaillet, N., Charest, C., et al. (2013). Preventable obstetrical interventions: How many caesarean sections can be prevented in Canada? Journal of Obstetrics and Gynaecology Canada, 35(5), 434–443. doi:10.1016/s1701-2163(15)30934-8.CrossRefPubMed Rossignol, M., Moutquin, J., Boughrassa, F., Bédard, M., Chaillet, N., Charest, C., et al. (2013). Preventable obstetrical interventions: How many caesarean sections can be prevented in Canada? Journal of Obstetrics and Gynaecology Canada, 35(5), 434–443. doi:10.​1016/​s1701-2163(15)30934-8.CrossRefPubMed
go back to reference Sagi, M., & Uhlmann, W. R. (2013). Genetic counseling services and training of genetic counselors in Israel: An overview. Journal of Genetic Counseling, 22(6), 890–896.CrossRefPubMed Sagi, M., & Uhlmann, W. R. (2013). Genetic counseling services and training of genetic counselors in Israel: An overview. Journal of Genetic Counseling, 22(6), 890–896.CrossRefPubMed
go back to reference Srebnik, N., Miron-Shatz, T., Rolison, J. J., Hanoch, Y., & Tsafrir, A. (2013). Physician recommendation for invasive prenatal testing: The case of the ‘precious baby’. Human Reproduction, 28(11), 3007–3011. doi:10.1093/humrep/det354.CrossRefPubMed Srebnik, N., Miron-Shatz, T., Rolison, J. J., Hanoch, Y., & Tsafrir, A. (2013). Physician recommendation for invasive prenatal testing: The case of the ‘precious baby’. Human Reproduction, 28(11), 3007–3011. doi:10.​1093/​humrep/​det354.CrossRefPubMed
go back to reference Stark, Z., Massie, J., McClaren, B., Ioannou, L., Cousens, N., Lewis, S., et al. (2013). Current practice and attitudes of Australian obstetricians toward population-based carrier screening for inherited conditions. Twin Research and Human Genetics, 16(02), 601–607. doi:10.1017/thg.2012.152.CrossRefPubMed Stark, Z., Massie, J., McClaren, B., Ioannou, L., Cousens, N., Lewis, S., et al. (2013). Current practice and attitudes of Australian obstetricians toward population-based carrier screening for inherited conditions. Twin Research and Human Genetics, 16(02), 601–607. doi:10.​1017/​thg.​2012.​152.CrossRefPubMed
Metadata
Title
Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability
Authors
Talya Miron-Shatz
Sivan R. Rapaport
Naama Srebnik
Yaniv Hanoch
Jonina Rabinowitz
Glen M. Doniger
Linda Levi
Jonathan J. Rolison
Avi Tsafrir
Publication date
01-02-2018
Publisher
Springer US
Published in
Journal of Genetic Counseling / Issue 1/2018
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-017-0120-9

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