Hiedemann Bridget, Vernon Erin, Bowie Bonnie H
Department of Economics, Seattle University, 901 12th Avenue, Seattle, WA 98122, USA.
College of Nursing, Seattle University, 901 12th Avenue, Seattle, WA 98122, USA.
J Pers Med. 2019 Jan 15;9(1):4. doi: 10.3390/jpm9010004.
The World Health Organization classifies combined hormonal contraception as an unacceptable health risk in the presence of a known thrombogenic mutation but advises against routine thrombophilia screening before initiating combined oral contraceptives (COCs) on the grounds of high screening costs and low prevalence. From the perspective of patient-centered care, we examine cost, prevalence, and other published arguments for and against thrombophilia screening before initiating COCs. Our patient-centered review draws on relevant empirical evidence concerning the advantages and disadvantages of thrombophilia screening, while placing the discussion in the broader context of evolving attitudes toward genetic testing and a shifting policy landscape that provides many women direct access to COCs and/or thrombophilia screening. Given variation in prior probabilities of thrombophilia, expected exposure to other risk factors for venous thromboembolism, attitudes towards risk, expected reactions to a positive test result, ability to pay, and concerns about genetic discrimination, we conclude that the current one-size-fits-most approach is not consistent with patient-centered care. Instead, we advocate for greater patient and provider education concerning the implications of thrombophilia screening. Moreover, we recommend offering patients optional thrombophilia screening before initiating COCs.
世界卫生组织将已知存在血栓形成基因突变时的复方激素避孕归类为不可接受的健康风险，但基于筛查成本高和患病率低的原因，建议在开始使用复方口服避孕药（COC）之前不要进行常规的血栓形成倾向筛查。从以患者为中心的护理角度出发，我们审视了在开始使用COC之前进行血栓形成倾向筛查的成本、患病率以及其他已发表的支持和反对筛查的观点。我们以患者为中心的综述借鉴了有关血栓形成倾向筛查利弊的相关实证证据，同时将讨论置于对基因检测态度不断演变以及政策格局不断变化的更广泛背景下，这种变化使许多女性能够直接获得COC和/或血栓形成倾向筛查。鉴于血栓形成倾向的先验概率存在差异、预期暴露于静脉血栓栓塞的其他风险因素、对风险的态度、对阳性检测结果的预期反应、支付能力以及对基因歧视的担忧，我们得出结论，当前的一刀切方法不符合以患者为中心的护理理念。相反，我们主张加强患者和提供者对血栓形成倾向筛查影响的教育。此外，我们建议在开始使用COC之前为患者提供可选的血栓形成倾向筛查。
