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家庭在儿童性染色体非整倍体诊断中的经历和态度。

Family experiences and attitudes about receiving the diagnosis of sex chromosome aneuploidy in a child.

机构信息

Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.

出版信息

Am J Med Genet C Semin Med Genet. 2020 Jun;184(2):404-413. doi: 10.1002/ajmg.c.31781. Epub 2020 Mar 17.

Abstract

The most common sex chromosome aneuploidies (SCA) (47, XXY; 47, XYY; 47, XXX) frequently result in a milder phenotype than autosomal aneuploidies. Nevertheless, these conditions are highly variable and more symptomatic phenotypes may require significant clinical involvement, including specialty care. While historically most individuals with mild phenotypes remained undiagnosed during their lifetime, the increasing use of genetic testing in clinical care has increased the prenatal and postnatal diagnosis of SCAs. These genetic tests are frequently ordered by nongenetic providers who are also responsible for delivering the diagnosis. We surveyed parents of children (n = 308) to evaluate their experience of receiving a diagnosis and their support needs. The majority (73.3%) received the diagnosis from a nongenetic medical provider. Following a prenatal diagnosis parents reported experiencing depression, anxiety, and less optimism than those receiving a postnatal diagnosis. Few parents reported receiving materials explaining their child's condition that they found to be up-to-date, accurate, and unbiased. The frequently negative reported experiences of parents at time of diagnosis suggests more educational opportunities should be provided for nongenetic providers in order to become more informed about these conditions and communicate the diagnosis in a way parents experience as supportive.

摘要

最常见的性染色体非整倍体(SCA)(47, XXY;47, XYY;47, XXX)通常比常染色体非整倍体表现出更轻微的表型。然而,这些情况具有高度的可变性,更明显的表型可能需要显著的临床干预,包括专业护理。尽管历史上大多数具有轻微表型的个体在其一生中都未被诊断出,但遗传检测在临床护理中的日益普及增加了 SCA 的产前和产后诊断。这些遗传测试通常由非遗传提供者下令进行,他们也负责提供诊断。我们调查了儿童的父母(n = 308),以评估他们接受诊断的经历和支持需求。大多数(73.3%)从非遗传医疗提供者那里获得了诊断。在产前诊断后,父母报告说经历了抑郁、焦虑,并且不如那些接受产后诊断的父母乐观。很少有父母报告说收到了他们认为是最新、准确和无偏见的解释孩子病情的材料。父母在诊断时经常报告负面的经历,这表明应该为非遗传提供者提供更多的教育机会,以便他们更了解这些情况,并以父母认为支持的方式传达诊断。

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