How do patient perceived determinants influence the decision making process to accept or decline preimplantation genetic screening

Capsule:
Costs, religious and ethical influences, provider and social support, as well as past reproductive experiences, contribute to a patient’s decision-making process to accept or decline PGS.

Authors:
Marty Brown Gebhart, D.N.P., N.P.-B.C., R.N.F.A., Randall S. Hines, M.D., Alan Penman, M.B.Ch.B., Ph.D., M.P.H., Aimee Chism Holland, D.N.P., W.H.N.P.-B.C., N.P.-C., R.D.

Volume 105, Issue 1, Pages 188-193

Abstract:

Objective:
Identify the determinants that influence the patient’s decision-making process when determining to accept or decline preimplantation genetic screening (PGS) in a given IVF cycle.

Design:
Pilot, retrospective, cross-sectional study that used a questionnaire containing a combination of quantitative and qualitative items.

Setting:
Private practice IVF clinic.

Patient(s):
Patients and partners initiating an IVF treatment cycle, both autologous and donor, between October 2012 and January 2015.

Intervention(s):
None.

Main Outcome Measure(s):
Identification of patient perceived determinants and the importance of each on the decision to accept or decline PGS.

Result(s):
Responses from the questionnaire (N = 117) were returned, and of these, 60% accepted PGS. The female response rate was 75% (N = 88) and the male response rate was 25% (N = 29). Ninety-eight percent were Christian (N = 112) and 88% college educated (N = 102) with 39% (N = 40) having some postgraduate education. Sixty-eight percent (N = 79) had no knowledge of PGS before the IVF cycle; however, after provider education, 92% (N = 108) correctly identified that PGS was elective and 93% (N = 109) reported sufficient knowledge to make an informed decision to accept or decline PGS. The additional cost of screening, the provider information and influence, and social support or acceptance from partner, family, and/or friends, were the three statistically significant variables affecting the decision.

Conclusion(s):
This is the first study, to the authors’ knowledge, to identify and assess the determinants of the patient decision-making process when presented with the choice of PGS. Several factors contribute to the patient-perceived determinants when choosing to accept or decline PGS, including cost, religious and ethical beliefs and values, social and family support, provider influences, and the past reproductive experience of the patient.

  • PGS is an important part of the IVF/ICSI process for many couples. This paper presents very interesting data as to the patient patterns and their decisions as to proceeding with PGS. Even though it is expensive, it is a way for the couple to ensure that they are protecting their “investment” and making sure they are stacking the odds in their favor. On the flip side, clinics could potentially use this to decrease their failed IVF cycles and improve their statistics by pressuring couples with potential PGS abnormalities not to transfer the embryos. At the end of the day, the take away from this is the importance of adequate counseling on the part of the clinician and shared decision making with the couple.

  • msamplaski

    These data are compelling, and in some ways reassuring (93% of couples reported that they had sufficient knowledge to make the decision for or against PGS). Moving forward, I would be curious to know in how many couples PGS changed the management of their fertility; In what percent did they choose embryos based on the results of the PGS? This would be valuable information for patients.

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