Implementing genomics in the neonatal period: An assessment of parental decision making and anxiety

Tasha Wainstein; Teresa Campbell; Biljana J Stojkova; Pascal M Lavoie; Alison M Elliott

doi:10.1002/jgc4.1605

Implementing genomics in the neonatal period: An assessment of parental decision making and anxiety

J Genet Couns. 2022 Dec;31(6):1306-1316. doi: 10.1002/jgc4.1605. Epub 2022 Jun 22.

Authors

Tasha Wainstein¹, Teresa Campbell¹, Biljana J Stojkova², Pascal M Lavoie^{3

4

5}, Alison M Elliott^{1

4

5}

Affiliations

¹ Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.
² Applied Statistics and Data Science, Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada.
³ Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ BC Children's Research Institute, Vancouver, British Columbia, Canada.
⁵ BC Women's Health Research Institute, Vancouver, British Columbia, Canada.

PMID: 35733279
DOI: 10.1002/jgc4.1605

Abstract

As uptake of rapid genome sequencing (GS) in the neonatal period steadily increases, a clinical genetics service that is optimized to the needs of parents becomes increasingly important. We aimed to investigate factors that influence decision making about rapid GS by parents of infants admitted to neonatal intensive care units (NICU) and explore their experiences of decisional conflict and anxiety during this time. Parents of neonates suspected of having a genetic disorder and offered rapid GS in the NICU completed a questionnaire measuring experience with GS counseling, decisional conflict, and anxiety level. Our results demonstrate that despite a largely positive GS experience (70%; 21/30) among the survey respondents, 50.0% (14/28) experienced moderate to severe anxiety measured using the GAD-7 scale, and 34.6% (9/26) experienced decisional conflict measured using the SURE scale. We also showed that prematurity may be a modifier of anxiety in this group of parents and although not statistically significant, distance lived away from the hospital site could have practical significance. Open-ended responses to survey questions highlighted that feeling overwhelmed, the types of engagements parents had with healthcare providers, and the timing of information provision also influenced parental decision making in this setting. We suggest that the GAD-7 scale for generalized anxiety and SURE scale for decisional conflict could be incorporated by genetic counselors into routine care of parents of neonates who have been offered rapid GS to identify those who may need additional support (resources, information, or psychological). These tools may inform ways that communication between patients and providers can be improved and enhanced and clinical genetics services in the NICU can be optimized. We suggest that integrating genetic counselors into the NICU care team could increase access for this population and ensure delivery of optimized patient education and counseling.

Keywords: anxiety; decision making; decisional conflict; genome sequencing; neonatal intensive care; parents.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety
Decision Making*
Genomics
Humans
Infant
Infant, Newborn
Intensive Care Units, Neonatal
Parents* / psychology