PRENATAL GENETIC TESTING--PROVIDER-PATIENT COMMUNICATION

产前基因检测通常由产科提供者提供。AS 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方面发挥更大的作用。虽然 文献存在于遗传学专业人士与他们的 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)，几乎 了解产科提供者(无论是医生还是护士 助产士)向他们的病人传达遗传信息。调查显示 对产科医生的态度和报告的做法进行了调查 基因测试和堕胎。然而，目前还没有研究表明 涉及助产士，而不是实际的沟通过程 孕妇和她们的产科提供者之间关于产前的 基因测试。我们将随机抽取60名产科青年 马里兰州的提供者和每个提供者10名33岁及以上的孕妇 (嵌套设计)实现三个目标。首先，我们将录下 对所有600对患者-提供者进行初步产前访问，以改善我们的 对产前遗传沟通的各种要素的理解 检测，与关于非遗传问题的沟通相比。元素 将侧重于道德方面的考虑，包括提供商的指导性、 所披露信息的准确性和完整性，并注意 保密协议。提供者的性别和受教育程度差异 沟通将通过比较男性产科医生和女性产科医生进行评估 产科医生和配备护士助产士的女性产科医生(20名提供者 在每组中)。磁带将使用Roter交互进行分析 分析系统。接下来，我们将采访患者参与者，以评估 沟通对他们的满意度和他们的 测试决策。最后，我们将对以下人员进行深入采访 提供商确定哪些因素会导致提供商的差异 沟通，包括他们的患者群体的性质，他们的 对基因检测和堕胎的态度及其所扮演的角色 在基因检测方面的沟通和决策责任 (关于披露、指导性和保密性)，其 对提供测试的既定指南的认识，他们的信心 在交流遗传信息方面，他们的转介做法 关于遗传咨询，以及他们对法律的关注/经验 责任。这一结果将对当前的利用产生影响 以及未来的产前基因检测，产科的教育和培训 关于产前基因检测的提供者和质量 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.