Is the non-respect of ethical principles by health professionals during first-trimester sonographic Down syndrome screening damaging to patient autonomyReport as inadecuate




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* Corresponding author 1 Département d-échographie et de Médecine fœtale 2 LEM - Laboratoire d-éthique médicale et médecine légale

Abstract : OBJECTIVES: To evaluate the understanding of health professionals involved in first-trimester ultrasound screening of the ethical stakes involved by addressing three questions regarding: how much these professionals know about Down syndrome screening by nuchal translucency thickness measurement; their personal opinion with respect to this screening test; and their attitude with respect to their patients, in order to answer the question: -Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?- METHODS: We studied the medical population in the east part of France by sending a questionnaire to each of 460 medical correspondents. This questionnaire attempted to evaluate the respondent-s level of medical knowledge, their personal opinion with respect to first-trimester screening and their attitude towards their patients. We adapted the three-dimensional diagram designed by Marteau et al. to develop a measure of informed choice regarding screening. Only health professionals who were relatively well informed and adopted an autonomy-oriented approach were considered to be in a position to obtain true consent from their patients, respecting ethical principles in terms of competence and the autonomy of patients. RESULTS: We received 276 60% responses to the questionnaire. Only 31.9% of health professionals had an approach that facilitated obtaining true consent from their patients and respected the ethical principles of competence and patient autonomy; 46% were in favor of the screening test and adopted an autonomy-oriented approach but were poorly informed; and 15.4% had a directive-authoritarian approach combined with poor knowledge. Regression analysis showed that two independent factors speciality P = 0.031 and location of practice P = 0.034 affected the level of medical knowledge, and two independent factors location of practice P = 0.034 and the type of medical practice i.e. public or private P < 0.05 affected the opinion of health professionals about the screening test. Two independent factors speciality P < 0.001 and the age of the health professional P = 0.02 affected the attitudes of health professionals towards their patients. CONCLUSION: The answer to the question -Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?- is clearly -No-. Major effort is required to ensure that the decisions made by patients are based on a possibility of true choice.





Author: Romain Favre - Virginie Guige - Anne-Sophie Weingertner - Christophe Vayssière - Monique Kohler - Israël Nisand - Christian Her

Source: https://hal.archives-ouvertes.fr/



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