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Is advice incompatible with autonomous informed choice? Womens perceptions of advice in the context of antenatal screening: a qualitative study

Authors: Shenaz Ahmed PhD,* Louise D. Bryant PhD,* Zahra Tizro PhD and Darren Shickle MD*

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Abstract
Background Patient autonomy in antenatal screening is a high
priority for policy developers in many countries.
Objective This paper presents womens understandings of how
health professionals should facilitate informed screening choices
with an emphasis on their understandings of autonomy and advice.
Design, setting and participants The study was carried out in 2009
in the UK, using a qualitative approach. Ninety-eight participants of
African, British White, Caribbean, Chinese and Pakistani origin had
semi-structured interviews, which were analysed using framework
analysis.
Results Four themes were identified during the analysis: Meanings
of advice in antenatal screening: the advice continuum,
Recognition of the role of health professionals in decision
making, Understandings of advice in the context of autonomous
decision making and Reasons given for wanting advice. Women
said they valued advice from health professionals to make
decisions about antenatal screening, but their understandings of
advice ranged from information giving only to direction about
screening choices.
Conclusion Many women wanted health professionals to support
the process of making informed choices by engaging in discussion
and did not see advice as incompatible with making autonomous
choices. However, some women wanted direction about whether to
have a screening test or not, something which policy and guidelines
explicitly prohibit. This may cause an ethical dilemma for health
professionals who are required to both support womens preference
for care and adhere to a policy of non-directiveness. Further
clarification is needed on how health professionals should support
the process of making informed choices when women ask for clear direction on screening choices.