Pilnick Alison M, Fraser Diane M, James David K
School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
Midwifery. 2004 Mar;20(1):82-93. doi: 10.1016/S0266-6138(03)00056-1.
to investigate the relationship between information giving by midwives and decision-making by women offered nuchal translucency (NT) screening. To establish how risk figures are discussed in practice, with the intention of relating this to the existing, and often critical, literature on women's accounts of antenatal screening.
a qualitative study following women through the process of being offered and deciding to undergo NT screening. Tape recording of consultations, analysed in their entirety, was combined with post-screening interviews.
a large teaching hospital in the UK.
fourteen pregnant women eligible for NT screening at the time of recruitment.
(i) tape recordings of consultations between community midwives and pregnant women where nuchal translucency screening was offered; (ii) tape recordings of consultations between hospital midwives and pregnant women immediately post-screening; (iii) individual face-to-face interviews with pregnant women between two and six weeks after the screening, carried out by the first author.
NT screening was in general well received, particularly by those women who had undergone serum screening with previous pregnancies. However, communicating the nature of a risk figure is an interactionally complex process. A large amount of interactional work is required by midwives both before and after screening to ensure that women comprehend this information. Despite the emphasis placed in these consultations on understanding the purpose of NT screening and the status of the results, women often framed their decision to undergo NT screening in terms of it being a formality, or of presuming that all was well. This sometimes created practical and personal difficulties in terms of decision-making.
previous sociological and psychological research has tended to be critical of midwives in terms of ensuring informed choice in screening, but this research is often based on post hoc accounts. Examining actual consultations with these accounts helps to illustrate the other factors that affect women's perceptions of testing, and the way in which risk, choice and decision-making are introduced and discussed in practice. Encouraging women to consider what action they might take on the basis of a personally unfavourable NT result in advance of undergoing the scan may help them to decide whether the information gained will be useful to them. Recognising the complex interactional work required in making sure that women understand the nature of the results that will be obtained is an important issue for the education and training of midwives.
调查助产士提供的信息与接受颈部透明带（NT）筛查的女性决策之间的关系。确定在实际操作中风险数字是如何讨论的，目的是将其与现有的、且往往具有批判性的关于女性产前筛查描述的文献联系起来。
一项定性研究，跟踪女性从被提供NT筛查到决定接受筛查的过程。对咨询过程进行全程录音并分析，同时结合筛查后的访谈。
英国一家大型教学医院。
招募时符合NT筛查条件的14名孕妇。
（i）社区助产士与提供颈部透明带筛查的孕妇之间咨询的录音；（ii）筛查后医院助产士与孕妇之间咨询的录音；（iii）第一作者在筛查后两到六周对孕妇进行的个人面对面访谈。
NT筛查总体上受到好评，尤其是那些在前次怀孕时接受过血清筛查的女性。然而，传达风险数字的性质是一个互动复杂的过程。助产士在筛查前后都需要进行大量的互动工作，以确保女性理解这些信息。尽管在这些咨询中强调了理解NT筛查的目的和结果的性质，但女性往往将接受NT筛查的决定视为一种形式，或者假定一切正常。这有时在决策方面造成了实际和个人困难。
以往的社会学和心理学研究往往批评助产士在确保筛查中的知情选择方面做得不够，但这类研究往往基于事后的描述。将这些描述与实际咨询情况相结合，有助于说明影响女性对检测认知的其他因素，以及在实际操作中风险、选择和决策是如何引入和讨论的。鼓励女性在进行扫描前提前考虑如果NT结果不理想她们可能采取的行动，这可能有助于她们决定所获得的信息是否对自己有用。认识到确保女性理解将获得的结果的性质所需的复杂互动工作，是助产士教育和培训的一个重要问题。
