Written patient information about triple-marker screening: A randomized, controlled trial

doi:10.1016/S0029-7844(97)00431-6

Obstetrics & Gynecology

Volume 90, Issue 5, November 1997, Pages 769-774

https://doi.org/10.1016/S0029-7844(97)00431-6 Get rights and content

Objective

To investigate to what extent a newly revised educational pamphlet on triple-marker screening improves patient knowledge and to identify subgroups of women who may not benefit from these materials.

Methods

Women in six geographically and demographically diverse Ontario sites were allocated randomly to receive the pamphlet on triple-marker screening or a similarappearing educational pamphlet on daily activities during pregnancy. The primary outcome measure was the Maternal Serum Screening Knowledge Questionnaire, a previously validated 14-item scale.

Results

Baseline demographic, obstetric, and medical factors were comparable in the intervention and control groups, as were measures of previous exposure to triplemarker screening. Knowledge scores were significantly higher among the 133 women receiving the intervention pamphlet than among 64 women who received the control pamphlet (0.89 versus 0.52 on a scale from −2 to +2, P < .001). Subgroups not benefiting from the pamphlet on triplemarker screening were women age 25 and younger and those not speaking English at home. Those who had completed university or postgraduate education had high levels of knowledge with and without the pamphlet.

Conclusion

Written patient information can contribute in an important way to patient knowledge about triple-marker screening. Providers of antenatal care should be made aware of the value of written patient information as well as the limitations for some subgroups of women. These subgroups are likely to require additional educational materials and resources. It would be appropriate to make these materials available to the general public and pregnant women in their physicians' offices.

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The objective of this study was to determine whether a web-based education strategy could improve maternal knowledge of placental complications of pregnancy and reduce maternal anxiety in high risk-pregnancies.
Prospective study in the Placenta Clinic at Mount Sinai Hospital, Toronto, Ontario. Maternal demographics and Internet usage were recorded at the patient’s baseline appointment. Placental knowledge was determined using structured verbal and illustrative assessments. The six-item State-Trait Anxiety Inventory (STAI) was administered to assess baseline maternal anxiety. Women were asked to visit the Placenta Clinic website for a minimum of 15 minutes before their follow-up appointment, at which time their placental knowledge and STAI assessments were repeated.
Eighteen women were included in the study. Patient knowledge at the baseline appointment was generally poor (median score 10.5 out of a maximum score of 27, range 1 to 22), with major deficits in basic placental knowledge, placenta previa/increta, and preeclampsia. At the follow-up appointment, placental knowledge was significantly improved (median score 23, range 10 to 27; P < 0.001). Educational status (high school or less vs. college or more) had no effect on either baseline knowledge or knowledge improvement. Maternal anxiety at baseline (median score 12 out of a maximum score of 24, range 6 to 23) was significantly reduced at the follow-up appointment (median score 8.5, range 6 to 20; P = 0.005).
Deficits in maternal knowledge of placental complications of pregnancy in high-risk pregnant women were substantial but easily rectified with a disease-targeted web-based educational resource. This intervention significantly improved patient knowledge and significantly reduced maternal anxiety.
Cette étude avait pour objectif de déterminer si une stratégie pédagogique sur le Web pouvait améliorer les connaissances maternelles en matière de complications placentaires de la grossesse et atténuer l’anxiété maternelle dans le cadre des grossesses exposées à des risques élevés.
Tenue d’une étude prospective au sein de la Placenta Clinic du Mount Sinai Hospital à Toronto, en Ontario. Les habitudes d’utilisation d’Internet et les caractéristiques démographiques maternelles ont été consignées au cours de la consultation de départ avec la patiente. Les connaissances quant au placenta ont été déterminées au moyen d’évaluations illustrées et verbales structurées. Le six-item State-Trait Anxiety Inventory (STAI) a été administré pour évaluer l’anxiété maternelle de départ. Nous avons demandé aux femmes de consulter le site Web de la Placenta Clinic pendant un minimum de 15 minutes avant leur consultation de suivi; au cours de celle-ci, leurs connaissances quant au placenta ont été évaluées à nouveau et les évaluations STAI ont été menées une fois de plus.
Dix-huit femmes ont participé à l’étude. Au moment de la consultation de départ, les connaissances des patientes étaient généralement faibles (score médian de 10,5 sur un score maximal de 27, plage de 1 à 22), des déficits majeurs ayant été constatés en matière de connaissances de base quant au placenta, au placenta prævia/increta et à la prééclampsie. Au moment de la consultation de suivi, les connaissances quant au placenta présentaient une amélioration considérablement accrue (score médian de 23, plage de 10 à 27; P < 0,001). Le niveau de scolarité (études secondaires ou moins vs études postsecondaires ou plus) n’a exercé aucun effet sur l’état des connaissances au départ ni sur l’amélioration des connaissances. L’anxiété maternelle au départ (score médian de 12 sur un score maximal de 24, plage de 6 à 23) avait connu une baisse considérable au moment de la consultation de suivi (score médian de 8,5, plage de 6 à 20; P = 0,005).
Les déficits en matière de connaissances maternelles quant aux complications placentaires de la grossesse chez les femmes enceintes exposées à des risques élevés étaient substantiels, mais facilement corrigeables au moyen d’une ressource pédagogique sur le Web axée sur la maladie. Cette intervention a mené à une amélioration significative des connaissances des patientes et à une baisse considérable de l’anxiété maternelle.
Decision aid tools to support women's decision making in pregnancy and birth: A systematic review and meta-analysis
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Citation Excerpt :
Knowledge refers to test results regarding improvement of the women's knowledge on the specific topic for which the tools have been designed. The effect of interventions on knowledge has been assessed by seven authors who evaluated nine tools by comparing scores obtained in the intervention group and control group (Bekker et al., 2004; Frost et al., 2009; Glazier et al., 1997; Hunter et al., 2005; Kuppermann et al., 2009; Montgomery et al., 2007; Nassar et al., 2007; Shorten et al., 2005; Stewart et al., 2003). Most tools separately showed highly significant increase in knowledge, except for the Decision Tree and Individual Counseling (not evaluated).
Support for a model of shared medical decision making, where women and their care providers discuss risks and benefits of their different options, reveal their preferences, and jointly make a decision, is a growing expectation in obstetric care. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of different decision aid tools compared to regular care for women facing several options in the specific field of obstetric care. We included published studies about interventions designed to aid mothers' decision making and provide information about obstetrical treatment or screening options. Following a search of electronic databases for articles published in English and French from 1994 to 2010, we found ten studies that met the inclusion criteria. In this systematic review and meta-analysis we found that all decision aid tools, except for Decision Trees, facilitated significant increases in knowledge. The Computer-based Information Tool, the Decision Analysis Tools, Individual Counseling and Group Counseling intervention presented significant results in reducing anxiety levels. The Decision Analysis Tools and the Computer-based Information tool were associated with a reduction in levels of decisional conflict. The Decision Analysis Tool was the only tool that presented evidence of an impact on the final choice and final outcome. Decision aid tools can assist health professionals to provide information and counseling about choices during pregnancy and support women in shared decision making. The choice of a specific tool should depend on resources available to support their use as well as the specific decisions being faced by women, their health care setting and providers.
Mothers' knowledge of screening for trisomy 21 in 1999: A survey in Paris maternity units
2002, European Journal of Obstetrics and Gynecology and Reproductive Biology
Objective: To assess mothers’ knowledge of screening tests for trisomy 21. Study Design: Interview of all women who had recently delivered a healthy child and were present in 15 Paris maternity units during one of the two non-consecutive days in June 1999 (N=734). Results: Two-third said that they had access to a nuchal translucency measurement (NTM) and to maternal serum screening (MSS), and 16% to amniocentesis. Thirty-eight percent of the women who had NTMs and 69% of those who had serum screening said that they had been informed of the need for amniocentesis if the results were abnormal. Among the women who had amniocentesis, 20% did not know the risk of miscarriage and 41% had not been informed about the possibility of terminating the pregnancy if trisomy 21 was diagnosed. Conclusions: Mothers’ knowledge about the screening tests for trisomy 21 remains fragmentary. Providing comprehensive information about all these tests should be considered in early pregnancy so that women can make informed choices.
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^**: Supported by the Ontario Ministry of Health and the Ontario Maternal Serum Screening Steering Committee.

¹: Dr. Goel is supported in part by a National Health Scholar Award from Health Canada.

View full text

Written patient information about triple-marker screening: A randomized, controlled trial**

Objective

Methods

Results

Conclusion

Patient Educ Couns

Obstet Gynecol

Patient Educ Couns

Prenatal screening for Down's syndrome with use of maternal serum markers

N Engl J Med

Sensitivity, specificity of screening for Down syndrome with alpha-fetoprotein, hCG unconjugated estriol, and maternal age

Obstet Gynecol

Maternal serum screening for Down's syndrome in early pregnancy

Br Med J

Maternal serum markers in screening for Down syndrome

Clin Genet

A prospective evaluation of a second trimester screening test for fetal Down syndrome using maternal serum alphafetoprotein hCG, and unconjugated estriol

Obstet Gynecol

Maternal serum screening for fetal Down syndrome in women less than 35 years of age using alpha-fetoprotein hCG, and unconjugated estriol: A prospective 2-year study

Obstet Gynecol

Anxiety, knowledge and satisfaction in women receiving false positive results on routine prenatal screening: A randomized controlled trial

J Psychosom Obstet Gynaecol