Academic journal article Pre- and Peri-natal Psychology Journal

Effect of Receiving Genetic Counseling on Pre-Event Anxiety in Genetic Amniocentesis Patients

Academic journal article Pre- and Peri-natal Psychology Journal

Effect of Receiving Genetic Counseling on Pre-Event Anxiety in Genetic Amniocentesis Patients

Article excerpt

ABSTRACT: Data were obtained as part of a larger experimental study of 48 genetic amniocentesis patients, ages 21 to 40. Information about genetic counseling was obtained through the demographic data questionnaire. State anxiety was measured before the procedure. Pre-event anxiety scores of women who had received genetic counseling before the day of the procedure were compared with those who had not received counseling before their appointment day. T-test for independent means revealed that those women who had counseling before the day of the procedure reported significantly less anxiety before the procedure than those who had no previous counseling. Prior counseling offers needed time for information integration and truly informed choice. The results are discussed in the context of the theoretical relationship between high anxiety levels before a threatening event and disruptions in emotion and coping during and after the procedure.

INTRODUCTION

Genetic amniocentesis is a procedure performed in the second trimester of pregnancy to diagnose genetic problems of the fetus. The current increased use of this procedure is directly related to the following factors: the large number of genetic disorders that can be diagnosed prenatally, the relative safety of the procedure, as well as increased public awareness and acceptance of the procedure.

Although emotional arousal related to genetic amniocentesis has been reported in the literature over the last decade, little attention has been focused on variables which impact this psychological response. Included among these variables are cognitive interpretation, perception of personal control and planned intervention. The beneficial effect of genetic counseling as an intervention to alter the emotional arousal has been assumed, however a search of medical and nursing literature (Cumulated index medicus and Cumulative index to nursing and allied health literature) indicate this outcome has not been documented.

One important purpose of genetic counseling is to identify women and couples who are candidates for genetic amniocentesis and other methods of prenatal genetic diagnosis. Ideally, genetic counseling should be offered to individuals and couples before pregnancy. Early counseling offers the opportunity for understanding those potential problems that may arise, and also permits the opportunity for identifying the best method for diagnosis (e.g. parental testing, chorionic villi sampling, amniocentesis, etc.). This provides the individual or couple with sufficient time to assimilate the information they have been given and to make informed decisions for the future.

In reality genetic counseling seldom takes place before pregnancy has already been established and genetic amniocentesis may be the only option available. In genetic amniocentesis patients, it has been documented that in many cases genetic counseling does not take place until the day of the procedure (Loranz, Willard & Botti, 1986), further limiting the possible choices and imposing forced decisions on the woman or couple. These decisions may be further influenced by what Rothman (1986) believes is a "compulsion to 'choose' the socially endorsed alternative" (p. 12) in reproductive choices.

Medical geneticists are ethically obligated to provide complete information for each individual case. Ideally, the counselee then carefully considers this information before making an autonomous decision (Fletcher, Berg & Tranoy, 1985). Time is an essential element in arriving at this decision. Counseling on the day of the procedure may contain little more than sufficient information for informed consent. Even an in-depth same-day session will still differ qualitatively from one that takes place earlier than the day of the procedure. In reality, Lorenz and colleagues (Lorenz, Botti, Schmidt & Ladda, 1985) found that patients who were counseled before the day of amniocentesis chose the procedure less often than those who received counseling on the day of the procedure. …

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