1. Reassurance and Anxiety Reduction Meaningful Informed Decision Making
Motivation for Non-Invasive Prenatal Testing Among Non-High Risk Patients: An Integrative Review of the Literature Eva Vanoer Faculty: Linda Graf, CNM, WHNP-C, DNP School of Nursing, DePaul University
Background
Conceptual Framework
Results
Low-risk mothers seek screening for reassurance and anxiety reduction, due to the accuracy of the testing, and to allow for meaningful decision making
The effectiveness of NIPT in the low-risk population is uniform in performance to that of the high-risk population
There are approximately four million births in the United States annually, of these live births, 1 in 33 is affected by birth defects
Aneuploidy, or chromosomal anomalies, are among the most significant birth defects and account for an estimated 30-60% of all miscarriages
The risk for trisomies increases with maternal age, previous children with trisomies, the presence of a balanced Robertsonian translocation in at least one parent, maternal obesity, use of tobacco products, and radiation exposure
Non-invasive prenatal testing (NIPT) has allowed for highly accurate screening for trisomy 21, 18, and 13 in high-risk expectant mothers since 2011
Despite high costs, ranging from $1700-$295, it is now often being used in the low-risk population
Few studies exist that illustrate why low-risk mothers want to elect this screening and if it as effective for them as it is for the high-risk population
Orem’s self-care theory was the conceptual framework used for this study
Centers on individuals initiating activities independently to maintain personal health and well-being
Engage in continuous communication with self & environments in order to function
Seeking knowledge of potential health problems is necessary for promoting self-care
The concepts within Orem’s theory suggest that expectant mothers elect NIPT in order to maintain self-care and wellbeing
The information received from the screening, whether positive or negative, allows for self-care to occur and for attainment of developmental self-care requisites
Motivator
Key Insights
Reassurance and Anxiety Reduction
To confirm risk status
To reassure the wellbeing of the fetus
To reduce maternal anxiety levels
Accuracy of Testing
More accurate over traditional screening modalities, such as biochemical assays and ultrasonography
lower rates of false-negative and false-positive test results
To obtaining most accurate info about fetus
Higher accuracy reduced need for more invasive procedures
Meaningful Informed Decision Making
Ability to make meaningful decisions about the pregnancy based on the results
Ability to prepare in the event of a positive result
Guiding termination decisions
Ability to know earlier in the pregnancy prior to strong emotional bonding
More in favor due to low fear of miscarriage from the procedure
Self-Care
Self-care demands
Nursing Agency
Self-Care Agency
Limitations
Very limited number of research articles are available on the low-risk expectant mother population and what motivates them to accept NIPT
Further studies using this specific population would be beneficial in understanding truly why they opt to obtain this expensive screening over existing screening methods
Additional studies on low-risk minority mothers would also provide more in depth understanding of the low-risk population and their concerns about aneuploidy in the prenatal period
Deficit
Purpose
Identify key motivators that influence low risk expectant mothers to undergo NIPT
Evaluate the effectiveness of NIPT for low-risk patients
Conclusion
Method
It was evident that low-risk expectant mothers accept NIPT for anxiety reduction and reassurance
More mothers are opting for this testing over the previous screening methods because of the high accuracy and specificity of the screening
NIPT allows early access to genetic information, thus providing families the opportunity to make thoughtful decisions in regards to their pregnancies
NIPT is just as effective in low-risk populations, and it is has improved accuracy over traditional screening methods
Due to the high interest in NIPT, nurses should expect genetic counseling to become a much larger aspect of prenatal care in the future
This study utilized an integrative literature review to locate relevant literature from the last ten years to determine motivators for low-risk mothers to undergo NIPT and its effectiveness.
The databases CINHAL, ProQuest, PsychInfo, and PubMed were used for the search
Inclusion criteria consisted of articles available in English, written within the last ten years, all publication types, and content related to the relevant key words
Key Words: non-invasive prenatal testing, non-invasive prenatal screening, cell-free DNA testing, NIPT, motivation
Research Questions
Why do low risk mothers elect to undergo NIPT testing instead of, or in addition to current standard screening methods?
Is NIPT as effective at diagnosing trisomies for low-risk patients as it is for high risk patients?