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产前cfDNA筛查结果提示母体肿瘤:当前实践与管理需求调查

Prenatal cfDNA screening results indicative of maternal neoplasm: survey of current practice and management needs.

作者信息

Giles Meagan E, Murphy Lauren, Krstić Nevena, Sullivan Cathy, Hashmi Syed S, Stevens Blair

机构信息

Genetic Counseling Program, University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.

Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, Houston, TX, USA.

出版信息

Prenat Diagn. 2017 Feb;37(2):126-132. doi: 10.1002/pd.4973. Epub 2016 Dec 16.

Abstract

OBJECTIVE

To determine genetic counselors' current practices and management needs for patients with prenatal cfDNA screening results indicative of maternal neoplasm.

METHODS

A survey was completed by genetic counselors recruited via the National Society of Genetic Counselors (NSGC).

RESULTS

Over 300 genetic counselors were surveyed. Almost all participants (95%) were aware that Noninvasive Prenatal Testing (NIPT) results may suggest maternal neoplasm, and 77% reported they would disclose such results. However, only 29% routinely communicate this possibility to patients in a pre-test setting. Management recommendations made by counselors were highly variable, and over half (51.8%) stated they would feel uncomfortable or very uncomfortable counseling a patient with these results. While less than half (44.3%) believed the current benefits of NIPT's ability to suggest maternal neoplasm outweigh its potential harms, 80.2% recognized it would be beneficial in the future. A vast majority of counselors (91.3%) felt institutional or national guidelines were needed for patient management.

CONCLUSION

A majority of counselors neither felt properly equipped nor comfortable counseling patients with prenatal cfDNA results suggestive of maternal neoplasm. This study demonstrates a need for collaboration amongst clinicians, researchers, and laboratories to publish data regarding NIPT results indicative of maternal neoplasm, and for the creation of management guidelines. © 2016 John Wiley & Sons, Ltd.

摘要

目的

确定遗传咨询师针对产前cfDNA筛查结果提示母体肿瘤患者的当前实践及管理需求。

方法

通过美国国家遗传咨询师协会(NSGC)招募的遗传咨询师完成了一项调查。

结果

共调查了300多名遗传咨询师。几乎所有参与者(95%)都意识到无创产前检测(NIPT)结果可能提示母体肿瘤,77%报告他们会披露此类结果。然而,只有29%在检测前常规地将这种可能性告知患者。咨询师提出的管理建议差异很大,超过一半(51.8%)表示他们在为有这些结果的患者提供咨询时会感到不舒服或非常不舒服。虽然不到一半(44.3%)的人认为NIPT提示母体肿瘤的当前益处超过其潜在危害,但80.2%的人认识到这在未来会有益处。绝大多数咨询师(91.3%)认为患者管理需要机构或国家指南。

结论

大多数咨询师既觉得没有充分的准备,也对为产前cfDNA结果提示母体肿瘤的患者提供咨询感到不自在。本研究表明临床医生、研究人员和实验室之间需要合作,以发表关于NIPT提示母体肿瘤结果的数据,并制定管理指南。© 2016约翰威立国际出版公司

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