PRENATAL GENETIC TESTING--PROVIDER-PATIENT COMMUNICATION

产前基因检测通常由产科提供者提供。 作为 新的产前基因检测激增，产科提供者将发挥作用， 在产前基因检测和咨询中发挥更大的作用。虽然 遗传学专业人员与他们的沟通方式的文献存在 患者，以及他们咨询的结果（即，患者 知识、合规性、测试决策和满意度）， 了解产科提供者（无论是医生还是护士） 助产士）将遗传信息传达给他们的病人。的调查 产科医生的态度和报告的做法， 基因检测和堕胎然而，没有研究表明， 涉及护士助产士，没有实际的沟通过程， 孕妇与其产科提供者之间关于产前 基因检测我们将随机抽取60名年轻产科医生， 马里兰州的提供者和10名33岁及以上的孕妇 （嵌套设计）以实现三个目标。首先，我们将录音 为所有600对患者提供者进行首次产前检查，以改善我们的 了解有关产前遗传的各种沟通要素 与非遗传问题的沟通相比，测试。元件 将侧重于道德方面的考虑，包括提供者的指导性， 披露信息的准确性和完整性，并注意 保密提供者的性别和教育差异 沟通将通过比较男性产科医生与女性 产科医生和女产科医生与助产士（20名提供者 在每一组）。将使用Roter Interaction分析磁带 分析系统接下来，我们将采访患者参与者， 沟通对他们的满意度的影响，以及对他们的 测试决定。最后，我们将深入采访 供应商，以确定哪些因素导致供应商的变化 沟通，包括他们的病人群体的性质，他们的 对基因检测和堕胎的态度，他们的角色， 基因检测的沟通和决策责任 (with关于披露、指导性和保密性）， 了解提供测试的既定指导方针，他们的信心 在交流遗传信息时，他们的转诊做法 遗传咨询，以及他们对法律的的关注/经验 责任。研究结果将对现有的 和未来的产前基因检测，产科医生的教育和培训， 提供者关于产前基因检测和质量的 决策过程

Prenatal genetic tests are routinely offered by obstetrical providers. As new prenatal genetic tests proliferate, obstetrical providers will play an even greater role in prenatal genetic testing and counseling. Although literature exists on the way genetics professionals communicate with their patients, and on the outcomes of their counseling (i.e., patient knowledge, compliance, testing decisions and satisfaction), little is known about the way obstetrical providers (whether physicians or nurse midwives) communicate genetic information to their patients. Surveys have been done on obstetricians' attitudes and reported practices regarding genetic testing and abortion. However, there have been no studies involving nurse midwives, and none of the actual communication process between pregnant women and their obstetrical providers regarding prenatal genetic testing. We will select a random sample of 60 young obstetric providers in Maryland and 10 pregnant women age 33 and over per provider (nested design) to accomplish three goals. First, we will audiotape the initial prenatal visit for all 600 patient-provider pairs to improve our understanding of various elements of communication about prenatal genetic testing, in comparison to communication about non-genetic issues. Elements will focus on ethical considerations including provider directiveness, the accuracy and completeness of information disclosed, and attention to confidentiality. Gender and educational differences in provider communication will be assessed by comparing male obstetricians with female obstetricians, and female obstetricians with nurse midwives (20 providers in each group). Tapes will be analyzed using the Roter Interaction Analysis System. Next, we will interview patient participants to assess the impact of that communication on their satisfaction, and on their testing decisions. Finally, we will conduct in-depth interviews of providers to determine what factors contribute to variation in provider communication, including the nature of their patient population, their attitudes toward genetic testing and abortion, their perceived role responsibility in communication and decisionmaking about genetic testing (with regard to disclosure, directiveness and confidentiality), their awareness of established guidelines for offering testing, their confidence in communicating about genetic information, their practices of referral for genetic counseling, and their concerns about/experience with legal liability. Results will have implications for the utilization of current and future prenatal genetic tests, the education and training of obstetric providers regarding prenatal genetic testing and the quality of the decision-making process.