title: Is advice incompatible with autonomous informed choice? Women's perceptions of advice in the context of antenatal screening: a qualitative study.
abstract: BACKGROUND
  Patient autonomy in antenatal screening is a high priority for policy developers in many countries.
  
  
  OBJECTIVE
  This paper presents women's understandings of how health professionals should facilitate informed screening choices with an emphasis on their understandings of autonomy and advice.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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 women's 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.
authors.affiliation: School of Medicine, Leeds Institute of Health Sciences, University of Leeds, LeedsFaculty of Health & Life Sciences, York St John University, Lord Mayor's Walk, York, UK.
authors.forename: Shenaz
authors.initials: S
authors.lastname: Ahmed
authors.forename: Louise D
authors.initials: LD
authors.lastname: Bryant
authors.forename: Zahra
authors.initials: Z
authors.lastname: Tizro
authors.forename: Darren
authors.initials: D
authors.lastname: Shickle
mesh_terms: D000328:Adult; D002755:Choice Behavior; D054626:Consumer Health Information / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods; D026684:Personal Autonomy; D011296:Prenatal Diagnosis / Q000523:psychology*; D024382:Professional Role; D036301:Qualitative Research; D012959:Socioeconomic Factors