In 2002, the number of amniocentesis procedures was 10-fold higher than 20 years earlier, with the majority conducted because of the advanced age of the mother (Mothers’ and Children’s Health and Welfare Association, 2004; Sago et al., 2000). Various studies (Ando, 1996; Aoki & Arimori, 2004; Rothenberg & Thomson, 1994) have indicated that women who undergo prenatal testing do not necessarily feel relieved after the test has been conducted. They experience conflict prior to testing, anxiety about the results, and feelings of guilt about having the test at all. There is also the added stress because they have to make the decision as to whether or not to undergo prenatal testing before the 22nd week of pregnancy, the cut-off date for pregnancy termination (Bryar, 1997; Kolker & Burke, 1993; Nakagomi, 2000).
In Japan, physicians largely provide genetic counseling independently. In this approach, the psychological stress of the client has not been resolved adequately. The genetic counseling system, including prenatal testing, was implemented in 2002 (Furuyama, 2001), with expectations that nurses would provide psychological support for the client’s decision as part of the team providing genetic counseling.
But there have been no reports of nurses using specific decision aid procedures (Arimori et al., 2004; Mihara, 2003; Nakagomi, Yokoo, Momota, Samura & Miharu, 2002; Suzuki et al., 2003; Yamashita, 2003; Yokoo, 2003). The Cochrane Library holds a systematic review of decision aids for people facing health treatment or decisions based on the results of screening tests (O’Connor et al., 2003). The Ottawa Personal Decision Guide, a unique decision aid developed for individuals, and its application in the health fields has been researched and discussed in particular. Therefore, the development of a decision aid program for women in Japan considering prenatal testing and a clear evaluation of its effectiveness would assist the decision-making process.
The aim of this study was to explore the effect of the Ottawa Personal Decision Guide on “decisional conflict” in women considering prenatal testing in Japan.
- 1Assess needs (determinants of decisions).
- 2Provide decision support intervention that addresses the determinants to improve the quality of the decision-making process and the decision aid.
- 3Evaluate the success of the decision support in affecting the quality of the decision process, the decision, and the decision outcome.
The interventions, as outlined in the Ottawa Personal Decision Guide (O’Connor et al., 2003), are:
- 1Clarify the decision.
- 2Identify your role in decision-making.
- 3Assess your decision-making needs.
- 4Weigh the options.
- 5Plan the next steps.
The outcomes were identified as determining the level of decisional conflict (primary outcome) and to assess self-esteem (SE; secondary outcome).The antecedents were identified as the clients’ and practitioners’ sociodemographic and clinical characteristics.