Interpretations of autonomous decision-making in antenatal genetic screening among women in China, Hong Kong and Pakistan
Interpretations of autonomous decision-making in antenatal genetic screening among women in China, Hong Kong and Pakistan
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DOI：
10.1038/s41431-017-0091-1
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发表时间：
2018-04-01
影响因子：
5.2
通讯作者：
Ahmed, Mushtaq
中科院分区：
文献类型：
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作者：
Ahmed, Shenaz;Yi, Huso;Ahmed, Mushtaq
产前筛查知情选择的概念包含西方意识形态，包含个人主义方法，来自集体主义文化国家的人可能会有不同的价值。本研究旨在探讨中国、香港和巴基斯坦妇女对产前筛查知情选择的看法。2016年6月至2017年2月在中国（上海和都匀）、香港和巴基斯坦（拉合尔）进行了一项Q方法学研究。共有299名妇女发表了41份声明。根据个人因素分析，确定了五种不同的观点：选择作为母亲的责任委托给医生;选择作为一个共同的决定，由母亲领导;选择作为一个共同的决定，由合作伙伴领导;选择作为一个责任委托给合作伙伴和医生;和宗教话语中的选择。研究结果突出了伦理困境的医疗保健专业人员在促进知情选择产前筛查的政策和实践指南适应主要是个人主义的方法。妇女倾向于与保健专业人员和/或其伴侣一起决策，而很少强调个人权利，这表明有必要澄清保健专业人员在支持和促进决策方面的作用，以加强妇女的自主权。政策和实践准则需要（重新）制定，以促进决策过程中产前筛查使用的自主关系的方法。
The concept of informed choice for antenatal screening consists of Western ideologies, encapsulating individualistic approaches, and may be valued differently by people from countries with more collectivist cultures. This study aimed to explore perceptions of informed choice in antenatal screening in women from China, Hong Kong and Pakistan. A Q-methodology study was conducted during June 2016 to February 2017, in China (Shanghai and Duyun), Hong Kong and Pakistan (Lahore). A total of 299 women rank ordered 41 statements. Following by-person factor analysis, five distinct viewpoints were identified: choice as a maternal responsibility entrusted to doctors; choice as a shared decision led by the mother; choice as a shared decision led by the partner; choice as a responsibility delegated to the partner and doctors; and choice within a religious discourse. The findings highlight ethical dilemmas for healthcare professionals in facilitating informed choice for antenatal screening where policy and practice guidelines adapt predominantly individualistic approaches. Women's preferences for decision-making with health professionals and/or their partner, with minimal emphasis on individual rights, suggest the need for clarification of the role of health professionals in supporting and facilitating decision-making to enhance women's autonomy. Policy and practice guidelines need to be (re)framed to facilitate decision-making processes for antenatal screening using relational approaches to autonomy.