Thornton J G, Hewison J, Lilford R J, Vail A
Institute of Epidemiology and Health Services Research, Leeds University.
BMJ. 1995 Oct 28;311(7013):1127-30. doi: 10.1136/bmj.311.7013.1127.
To test the effect of extra non-directive information about prenatal testing, given individually or in a class.
Antenatal clinics in a district general hospital and a university hospital.
Randomised controlled trial; participants allocated to control group or offer of extra information individually or in class.
1691 women booking antenatal care before 15 weeks' gestation.
All participants received the usual information about prenatal tests from hospital staff. Individual participants were offered a separate session with a research midwife in which prenatal screening was described in detail. Class participants were offered the same extra information in an early prenatal class.
Attendance at extra information sessions; uptake rates of prenatal tests; levels of anxiety, understanding, and satisfaction with decisions.
Attendance at classes was lower than at individual sessions (adjusted odds ratio 0.45; 95% confidence interval 0.35 to 0.58). Ultrasonography was almost universally accepted (99%) and was not affected by either intervention. Uptake of cystic fibrosis testing, high in controls (79%), was lowered in the individual group (0.44; 0.20 to 0.97) and classes (0.39; 0.18 to 0.86). Uptake of screening for Down's syndrome, already low (34%) in controls, was not further depressed by extra information in classes (0.99; 0.70 to 1.39) and was slightly higher in the individual group (1.45; 1.04 to 2.02). Women offered extra information had improved understanding and were more satisfied with information received; satisfaction with decisions about prenatal testing was unchanged. The offer of individual information reduced anxiety later in pregnancy.
Ultrasonography is valued for non-medical reasons and chosen even by fully informed people who eschew prenatal diagnosis. The offer of extra information has no overall adverse effects on anxiety and reduces uptake of blood tests when background uptake rate is high (but not when it is already low). High uptake of prenatal blood tests suggests compliant behaviour and need for more information.
测试单独或集中提供的关于产前检查的额外非指导性信息的效果。
一家区综合医院和一家大学医院的产前诊所。
随机对照试验；参与者被分配到对照组，或单独或集中获得额外信息。
1691名在妊娠15周前预约产前护理的妇女。
所有参与者均从医院工作人员处获得关于产前检查的常规信息。单独接受干预的参与者会与一名研究助产士单独会面，详细介绍产前筛查。集中接受干预的参与者在早期产前课程中获得相同的额外信息。
参加额外信息课程的情况；产前检查的接受率；焦虑水平、理解程度以及对决策的满意度。
集中课程的参与率低于单独会面（调整后的优势比为0.45；95%置信区间为0.35至0.58）。超声检查几乎被普遍接受（99%），且不受任何一种干预措施的影响。囊性纤维化检测的接受率在对照组较高（79%），在单独接受干预的组中降低（0.44；0.20至0.97），在集中接受干预的组中也降低（0.39；0.18至0.86）。唐氏综合征筛查的接受率在对照组本来就较低（34%），在集中接受额外信息的组中并未进一步降低（0.99；0.70至1.39），在单独接受干预的组中略高（1.45；1.04至2.02）。获得额外信息的女性理解能力有所提高，对所获信息更满意；对产前检查决策的满意度没有变化。提供单独信息可降低孕期后期的焦虑。
超声检查因非医学原因受到重视，即使是那些了解情况并回避产前诊断的人也会选择。提供额外信息对焦虑没有总体不利影响，在背景接受率较高时会降低血液检查的接受率（但在接受率本来就低时不会）。产前血液检查的高接受率表明存在依从行为且需要更多信息。
