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Interpretations of informed choice in antenatal screening: A cross-cultural, Q-methodology study

Authors: Shenaz Ahmed a,*, Louise D. Bryant a, Zahra Tizro b, Darren Shickle

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A b s t r a c t
Informed choice is internationally recognised and accepted as an important aspect of ethical healthcare.
In the UK, NHS antenatal screening policies state that their primary aim is to facilitate reproductive
informed choices. These policies, implemented within a multiethnic population, are largely guided by the
ethical principle of autonomy. This study was carried out in 2009 in the UK and used Q-methodology to
explore diversity in the value attached to autonomous informed choice in antenatal screening for genetic
disorders and similarities and differences in this value in women from different ethnic origins. Ninetyeight
participants of African, British White, Caribbean, Chinese and Pakistani origin completed a 41-
statement Q-sort in English, French, Mandarin or Urdu. Q-Factor analysis produced five statistically
independent viewpoints of the value of informed choice: choice as an individual right; choice informed
by religious values; choice as a shared responsibility; choice advised by health professionals; and choice
within the family context. The findings show that women hold a variety of views on the nature of
informed choice, and that, contradictory to policies of autonomous informed choice, many women seek
and value the advice of health professionals. The findings have implications for the role of health
professionals in facilitating informed choice, quality of care and equity of access