PRENATAL GENETIC TESTING--PROVIDER-PATIENT COMMUNICATION

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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.