孕婦對產前唐氏症篩檢知情選擇之闡釋—Q方法之運用

背景：產前遺傳檢驗科技日新月異，不只提升唐氏症胎兒的偵測率，提供更多元的選擇；然而，有關檢驗資訊、檢驗結果與後續診斷之決定，卻可能對孕婦個人或家庭產生衝擊。知情選擇(informed choice)的概念係指在相關的高品質資訊為基礎的前提下，所作出符合決策者價值觀的選擇。目前英國孕婦產前照護指引依循知情選擇的精神，協助孕婦能夠權衡利弊與自身價值觀做出決定，以降低其對篩檢的焦慮感或負面心理影響，反觀國內則仍停留在知情同意之階段。目的：探索孕婦闡釋唐氏症篩檢知情選擇的方式，及歸納孕婦對唐氏症篩檢知情選擇之闡釋類型。方法：本研究於臺北市某區域醫院，以Q方法探討孕婦做唐氏症篩檢決定的知情選擇的闡釋，對象為懷孕週數24週以前，且此胎尚未進行唐氏症篩檢的成年孕婦。結果：本研究共100位孕婦參與。以Q方法可將孕婦分為四類，分別為依賴專業建議型、家庭集體決策型、自信決策型，及女方家庭參與決策型。各類型孕婦對唐氏症篩檢的知情選擇不盡相同，不過孕婦一致認為孩子是兩個人的，應該和伴侶一起做決定；此外，醫療人員提供的資訊也是不可或缺的。結論：本研究呈現孕婦對產前唐氏症篩檢知情選擇有不同的闡釋，有助於醫療人員依孕婦不同的闡釋方式給予客製化的衛生教育或遺傳諮詢。

關鍵字

唐氏症篩檢；知情選擇； Q方法；決策；醫病共享決策

並列摘要

Introduction Prenatal screening technologies have recently been advanced, therefore, women now have many more options. However, the decisions made on the screening and diagnosis has generated a significant impact, not only on women themselves, but also on their families. Informed choice has been recognized as an important component of the quality healthcare, and it is vital for improving the quality of the maternal care. The objective of this study is to explore the different viewpoints regarding an informed choice in the antenatal screening, and the decision making experiences among pregnant women. Methods The study was conducted at a regional hospital in Taipei, Taiwan. We conducted a Q-method with 100 pregnant women who had no antenatal screening with less than 24 weeks of gestation. Results The Q-Factor analysis produced four statistically independent viewpoints on the value of the informed choice: choice advised by the health professionals; choice as a family collective decision; choice as a self-confident decision; and choice as a decision shared by the women’s family. Conclusions and Recommendations Many women value the advice of the health professionals and would like to make their own decision with their partner. There is diversity in women’s viewpoints when attached to an informed choice in the antenatal screening. Some of these viewpoints contradict the informed choice which is interpreted by individualism. Apart from providing information, women can be supported to make an informed choice by empowerment interventions towards communication, and to make the correct decisions for themselves.