title: Decision-making on terminating pregnancy for Muslim Arab women pregnant with fetuses with congenital anomalies: maternal affect and doctor-patient communication.
abstract: BACKGROUND
  This study focused on decision-making on terminating pregnancy for Arab Muslim women in Israel who were pregnant with fetuses diagnosed with congenital anomalies. It examined the impact of the doctor-patient interaction on the women's decision, especially in light of social and religious pressures not to terminate under any circumstances. Our goal was to identify perceptions and attitudes of Muslim Arab women who choose to continue their pregnancy following the detection of congenital anomalies in prenatal tests. Specific objectives included (1) To examine the Muslim Arab women's perceptions on genetic testing, and ascertain the reasons for their decision to continue the pregnancy following the detection of a congenital anomaly in the fetus; and (2) To examine risk communication of gynecologists regarding genetic testing and abortions, and regarding the decision of continuing or terminating a pregnancy following detection of a congenital anomaly.
  
  
  METHODS
  The research framework used the constructivist classical qualitative method to understand the experience of women at high risk for congenital anomalies and their experience of how doctors communicate the risk.
  
  
  RESULTS
  It showed that the emotional element is no less dominant than religious and social elements. The findings emphasized the disparities between doctors and women regarding emotional involvement (non-directive counselling). The women interviewees (N = 24) felt that this expressed insensitivity. As far as we know, the emotional component has not been raised in previous studies of Muslim women at high risk for congenital defects in their fetus, and therefore comprises a significant contribution of the present study.
  
  
  CONCLUSIONS
  To mitigate gaps, doctors should take affect into consideration in their communication with patients. It is important for doctors to understand the emotional element in risk communication, both in how they respect women's emotions and in creating an emotional interaction between themselves and the women.
authors.affiliation: School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel. ageser@univ.haifa.ac.il.
authors.forename: Anat
authors.identifier: http://orcid.org/0000-0003-4467-8799
authors.initials: A
authors.lastname: Gesser-Edelsburg
authors.affiliation: School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel.
authors.forename: Nour Abed Elhadi
authors.initials: NA
authors.lastname: Shahbari
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D018912:Arabs; D003142:Communication; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D003657:Decision Making; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D006801:Humans; D007514:Islam; D008425:Maternal Behavior / Q000523:psychology*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011247:Pregnancy; D011296:Prenatal Diagnosis; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: Decision-making on terminating pregnancy; Doctor-patient risk communication; Fetuses with congenital anomalies; Maternal affect; Pregnant Muslim Arab women