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. 2010 Nov 10;2010(11):CD007750.
doi: 10.1002/14651858.CD007750.pub2.

Different communication strategies for disclosing results of diagnostic prenatal testing

Faris Mujezinovic  1 , Anica Prosnik, Zarko Alfirevic
Affiliations

Different communication strategies for disclosing results of diagnostic prenatal testing

Faris Mujezinovic et al. Cochrane Database Syst Rev. .

Abstract

Background: Any screening program aiming to reassure pregnant women that their unborn baby is healthy will cause anxiety while waiting for the test results.

Objectives: 1) To determine if revealing amniocentesis or chorionic villous sampling (CVS) results on a fixed date alters maternal anxiety during the waiting period, compared with a policy of revealing the result "when available" (i.e. variable date). 2) To evaluate whether issuing early results from a rapid molecular test alters maternal anxiety during the waiting period. 3) To evaluate whether different methods of communication (telephone, fax, email, face to face) have any impact on the parents' satisfaction and anxiety levels.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2010).

Selection criteria: All published and unpublished randomised trials, in which methods of issuing prenatal test results are compared.

Data collection and analysis: Two review authors (Faris Mujezinovic and Zarko Alfirevic) assessed eligibility and trial quality and performed data extraction.

Main results: Two studies (involving 286 women) from amniocentesis (but none from CVS) compared the impact of communicating results of rapid testing with waiting for definitive karyotype. Unfortunately, it was not possible to perform pooled analysis because one study reported only median (interquartile range) data, presumably because the data were not normally distributed.One study reported a statistically significant reduction in the average anxiety during the waiting period for women who had had a rapid test compared with those who had not (mean difference (MD) -2.30, 95% confidence intervals (CI) -3.08 to - 1.52). The other study compared median (interquartile range) for the trait- and state-anxiety scores and found no difference between the two groups.

Authors' conclusions: We found no conclusive evidence that, while waiting for the full karyotype following amniocentesis, issuing results from a rapid analysis reduces maternal anxiety. The limited evidence from the two trials included in this review does not help resolve the dilemma about whether full karyotyping should be abandoned in favour of limited rapid testing for women undergoing Down's syndrome screening. This choice will rest on clinical arguments and cost-effectiveness rather than impact on anxiety.There is also no evidence to support the view that issuing amniocentesis results as soon as they are available is more user friendly than using a pre-defined fixed date. Studies evaluating the effect of different strategies for disclosing results on women anxiety for CVS are needed.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 1 Average anxiety level during the waiting period.
1.2
1.2. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 2 The peak anxiety in the waiting period.
1.3
1.3. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 3 The length of time to the first peak anxiety.
1.4
1.4. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 4 The total anxiety in the 11 days following amniocentesis.
1.5
1.5. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 5 The average anxiety from day 12 to karyotype results day.
1.6
1.6. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 6 The total anxiety from test day to day 21.
1.7
1.7. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 7 Total anxiety level in first 4 days after the AC.
1.8
1.8. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 8 The total anxiety for the 7 days prior to karyotype results day.
1.9
1.9. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 9 Recalled anxiety, thinking about the 10‐12 days following the amniocentesis test.
1.10
1.10. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 10 Recalled anxiety, thinking about 2‐3 days prior to receiving karyotype result.
1.11
1.11. Analysis
Comparison 1 Rapid method versus no rapid method, Outcome 11 Anxiety level after 1‐month follow‐up after AC.
2.1
2.1. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 1 Average anxiety level during the waiting period.
2.2
2.2. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 2 The peak anxiety in the waiting period.
2.3
2.3. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 3 The length of time to the first peak anxiety.
2.4
2.4. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 4 The total anxiety in the 11 days following amniocentesis.
2.5
2.5. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 5 The average anxiety from day 12 to karyotype results day.
2.6
2.6. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 6 The total anxiety from test day to day 21.
2.7
2.7. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 7 Total anxiety level in first 4 days after the AC.
2.8
2.8. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 8 The total anxiety for the 7 days prior to karyotype results day.
2.9
2.9. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 9 Recalled anxiety, thinking about the 10‐12 days following the amniocentesis test.
2.10
2.10. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 10 Recalled anxiety, thinking about 2‐3 days prior to receiving karyotype result.
2.11
2.11. Analysis
Comparison 2 Variable date versus fixed date of communicating results, Outcome 11 Anxiety level after 1‐month follow‐up after AC.
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References

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