title: Communication with patients during the prenatal testing procedure: an explorative qualitative study.
abstract: OBJECTIVE
  While generally two phases of prenatal genetic counseling are distinguished, i.e. pre- and post-test counseling, we revealed a third form of communication during the testing procedure. The content of this intermediate communication was explored.
  
  
  METHODS
  A secondary analysis was performed on data obtained in another observational study, which was focussed on how indefinite testing results are clarified. Thirteen testing trajectories in which communication with parents took place during the testing procedure were further analysed.
  
  
  RESULTS
  In the majority of cases the content of intermediate communication was similar to the content of pre-test counseling. In four cases the content was different, because the communication involved the parents in decision-making about a testing result, which was still being processed.
  
  
  CONCLUSIONS
  Communication in (prenatal) genetic testing is not always restricted to separate phases, but can be an ongoing process occurring parallel to, and sometimes even intertwined with, the testing process. The advocated model of shared decision-making might work better once it is determined if the decision concerns the area wherein the provider is the expert, or the patient.
  
  
  CONCLUSIONS
  Further research into the process of continuing decision-making could clarify how providers' and patients' responsibilities regarding the diagnostic process are distributed. Meanwhile, the possible occurrence of continuous decision-making should be mentioned in (prenatal) genetic counseling.
authors.affiliation: Academic Medical Center, University of Amsterdam, Division Clinical Methods and Public Health, Department of General Practice, Family Medicine, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.c.vanzwieten@amc.uva.nl
authors.forename: Myra
authors.initials: M
authors.lastname: van Zwieten
authors.forename: Dick
authors.initials: D
authors.lastname: Willems
authors.forename: Lia
authors.initials: L
authors.lastname: Knegt
authors.forename: Nico
authors.initials: N
authors.lastname: Leschot
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D025063:Chromosome Disorders / Q000175:diagnosis; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D030881:Disclosure; D005817:Genetic Counseling / Q000458:organization & administration / Q000523:psychology*; D005820:Genetic Testing / Q000458:organization & administration / Q000523:psychology*; D006040:Goals; D006801:Humans; D007258:Informed Consent / Q000523:psychology; D008423:Maternal Age; D008960:Models, Psychological; D017008:Negotiating / Q000523:psychology; D010290:Parents / Q000193:education / Q000523:psychology; D010353:Patient Education as Topic / Q000458:organization & administration; D010358:Patient Participation / Q000523:psychology; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations; D011296:Prenatal Diagnosis / Q000523:psychology*; D036301:Qualitative Research; D012944:Social Support; D013997:Time Factors