Educational Game vs Genetic Counseling for Prenatal Screening Education

Recruiting at 2 trial locations

Overseen By Erin Johnson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Erin Rothwell

Disqualifiers: Previous prenatal screening, Genetic counseling, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

1125 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine the best way to educate pregnant people about prenatal genetic screening, which identifies certain conditions in the baby before birth. It compares three educational methods: standard brochures, one-on-one genetic counseling (a personalized session with a healthcare professional), and a new educational game. The researchers aim to assess if the game can be as effective as genetic counseling, which remains inaccessible in some areas. Pregnant individuals who are less than 15 weeks along, can speak English, and can use a computer or smartphone from home might be a good fit for this study.

As an unphased trial, this study offers a unique opportunity to contribute to improving prenatal education methods for future parents.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this educational game is safe for prenatal screening education?

Research has shown that the Meaning of Screening game, a tool for understanding prenatal screening, has been well-received in past studies. In one study, participants randomly assigned to use the game effectively learned about prenatal screening without major side effects. Those who used the game found it helpful for decision-making.

Genetic counseling, a common practice, has a strong safety record. Studies indicate that these sessions typically last about 60 minutes and provide important information about genetic risks without causing harm. Counseling is a safe and reliable way for expectant parents to learn about prenatal screening.

Both the educational game and genetic counseling offer safe ways to learn more about prenatal screening. Participants can trust that these methods have been tested and are well-accepted. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it's exploring new ways to educate pregnant women about prenatal screening. The trial compares traditional genetic counseling and usual brochure-based education with an innovative educational game delivered on an electronic platform. The game intervention stands out because it uses interactive technology to engage participants, potentially making complex information easier to understand and remember. This approach could revolutionize how prenatal screening information is shared, offering a more personalized and engaging experience than the usual pamphlets or one-on-one counseling sessions. By evaluating these different methods, researchers hope to discover which is most effective in helping women make informed decisions about prenatal screening.

What evidence suggests that this trial's treatments could be effective for prenatal screening education?

This trial will compare the effectiveness of different educational methods for prenatal screening. Research has shown that using a game, which participants in the Game Intervention arm will experience, effectively teaches pregnant women about prenatal screening. One study found that this game can increase knowledge and reduce uncertainty about screening choices. The game offers interactive learning, which can be more engaging than traditional methods.

In the Genetic Counseling arm, participants will receive one-on-one sessions with a genetic counselor. Studies have shown that genetic counseling effectively provides clear and detailed information about prenatal screening. Genetic counselors help reduce anxiety and improve understanding by explaining complex information in an easy-to-understand way. Both the game and counseling methods, tested in this trial, have shown promise in improving prenatal education, although they work differently to achieve this goal. ^{2 5 6 7 8}

Who Is on the Research Team?

Erin Rothwell, PhD

Principal Investigator

University of Utah

Are You a Good Fit for This Trial?

This trial is for English-speaking adults less than 15 weeks pregnant, attending their first or second OB clinic visit, including those in rural areas. Partners of the pregnant individuals can also join if they're adults and speak English. It's not for those who've had prenatal screening before or have a high-risk pregnancy with prior genetic counseling.

Inclusion Criteria

Able to complete study tasks on a computer or smartphone from home

I am an adult who speaks English and my partner is pregnant.

I am less than 15 weeks pregnant.

Exclusion Criteria

I have a family history of genetic issues and have seen a genetic counselor.

Already had prenatal screening from this or previous pregnancies

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants are randomized to either game education, enhanced usual care, or one-on-one genetic counseling

6-14 weeks gestation

1-2 visits (in-person or tele-health)

Follow-up

Participants complete surveys to measure knowledge, satisfaction, and decisional conflict

20 weeks gestation

1 survey (remote)

Long-term Follow-up

Interviews with participants and clinicians to assess shared decision-making and information needs

What Are the Treatments Tested in This Trial?

Interventions

• Genetic Counseling
• Meaning of Screening
• Usual Care

Trial Overview The study compares a new educational game designed to teach about prenatal genetic screening against the usual one-on-one genetic counseling approach. The goal is to see if the game can effectively fill knowledge gaps where access to counselors is limited.

How Is the Trial Designed?

Group I: Game Intervention Experimental Treatment 1 Intervention

The game intervention group will consist of pregnant women who will interact with the educational intervention also delivered on an electronic platform (n= 375 total, 125 per site). Participants will also receive whatever information is routinely provided in the clinic about prenatal screening such as the brochure and oral information by clinicians.

Group II: Usual Care Active Control 1 Intervention

The usual care group will consist of pregnant women who receive no experimental intervention but will receive the brochure-based education about prenatal screening that is currently recommended by American College of Obstetrics and Gynecology (ACOG), delivered in an electronic format, plus any additional clinic materials or oral information provided in conversation with clinicians (n= 375 total, 125 per site). We are transferring ACOG's prenatal screening education onto the electronic platform to control for any differences in attention that may be due to technology platform and to track time interacting with the material via the web portal.

Group III: Genetic Counseling Active Control 1 Intervention

The one-on-one genetic counseling group will receive standard of care for genetic counseling delivered by a board-certified genetic counselor for pre-test education. The counselor will be conducting pre-test education and as with the other study groups, the decision about prenatal screening will be made at the clinical visit with the provider. This group receives also the same clinical materials and oral information by clinicians as the other two groups. Both in-person and tele-health genetic counseling options are available at all sites.

Who Is Running the Clinical Trial?

Erin Rothwell

Lead Sponsor

Trials

2

Recruited

7,100+

National Human Genome Research Institute (NHGRI)

Collaborator

Trials

273

Recruited

299,000+

Published Research Related to This Trial

A study involving 298 pregnant women who were carriers of hemoglobinopathies showed that genetic counseling significantly improved their knowledge about clinical manifestations, genetics, and prenatal diagnosis related to their conditions.

Factors such as younger age, higher education, prior knowledge of their carrier status, and having no previous children were associated with better knowledge scores after counseling, indicating that these elements may enhance the effectiveness of genetic counseling.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prenatal screening for hemoglobinopathies. II. Evaluation of counseling. Loader, S., Sutera, CJ., Walden, M., et al.[2020]

Prenatal care providers must navigate complex decisions regarding genetic screening and testing, emphasizing the need for tailored approaches that fit their patient populations and workflows.

The workshop highlighted the critical role of pre- and post-test counseling in genetic testing, ensuring that patients receive appropriate information and support throughout the process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What are the required components of pre- and post-test counseling? Rink, BD., Kuller, JA.[2019]

The study explored the feasibility of using group information sessions as an alternative to traditional one-on-one genetic counseling for prenatal testing, which is becoming increasingly important with the rise of cell-free DNA screening.

Results indicated that these group sessions, combined with shorter counseling, effectively improved pregnant women's knowledge and attitudes towards prenatal testing, suggesting a potential shift in how genetic counseling can be delivered to accommodate more women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing Group Prenatal Counseling for Expanded Noninvasive Screening Options. Gammon, BL., Otto, L., Wick, M., et al.[2019]

A study involving 126 parents of children with Down syndrome found that those who received genetic counseling had better knowledge about the condition, especially parents from the Down Syndrome Association.

Parents prioritized education and medical care topics over genetic information in counseling, suggesting that addressing these concerns could enhance the effectiveness of genetic counseling sessions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A follow-up study of genetic counseling in Down syndrome. Lin, SJ., Huang, MC., Chen, SH., et al.[2015]

New technologies in prenatal screening, such as expanded carrier screening and non-invasive cell-free fetal DNA tests, have improved the detection of genetic abnormalities in fetuses, allowing for earlier and more comprehensive assessments.

Advanced methods like chromosomal microarray analysis and whole-exome sequencing can diagnose a wider range of genetic conditions from invasive samples, but they also complicate genetic counseling for healthcare providers as they navigate the benefits and limitations of these options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recent advances in prenatal genetic screening and testing. Van den Veyver, IB.[2022]

The paper clarifies that 'genetic screening' and 'prenatal screening' are distinct concepts, with prenatal screening currently lacking a strong connection to precise genetic definitions.

By accurately defining these terms, the paper suggests that it could improve policy-making and public understanding regarding the benefits and limitations of screening practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prenatal screening and genetics. Alderson, P., Aro, AR., Dragonas, T., et al.[2019]

Both group genetic counseling methods (presentation by a genetics professional and audiovisual presentation) effectively improved patients' knowledge about prenatal cystic fibrosis screening, with no significant difference in screening choices between the two methods.

Fifty-eight percent of patients opted for screening, leading to the identification of 15 mutation carriers, but partner testing was challenging, highlighting potential issues in mobile populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing prenatal screening for cystic fibrosis in routine obstetric practice. Fries, MH., Bashford, M., Nunes, M.[2006]

A study involving 22 racially and ethnically diverse women revealed that current prenatal screening educational methods do not adequately meet patients' needs for understanding, especially regarding high-risk results.

Participants suggested that a standardized decision aid could enhance knowledge and reduce confusion by providing clear information about testing options, conditions screened, timelines, costs, and using non-technical language.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding the experiences and perspectives of prenatal screening among a diverse cohort. Riches, NO., Johnson, EP., Subramaniam, A., et al.[2023]

Genetic counseling provides essential information about the causes of genetic conditions, recurrence risks, and treatment options, helping clients make informed decisions about their health.

The effectiveness of genetic counseling is influenced by the existing knowledge, values, and beliefs of both the client and the counselor, highlighting the importance of personalized communication in the counseling process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Discovering and addressing the client's lay construct of genetic disease: an important aspect of genetic healthcare? Skirton, H., Eiser, C.[2019]

Both conventional counseling by a physician and programmed counseling using a videotape resulted in similar improvements in knowledge about beta-thalassemia and genetics among adults screened for the trait, indicating that the method of delivery does not significantly affect learning outcomes.

Using videotaped counseling can significantly reduce the time healthcare professionals spend on genetic counseling while still effectively educating patients, making it a practical option for integrating genetic screening into primary health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Genetic counseling for beta-thalassemia trait following health screening in a health maintenance organization: comparison of programmed and conventional counseling. Fisher, L., Rowley, PT., Lipkin, M.[2020]

Prenatal testing for conditions like Down syndrome and neural tube defects is now routine, but effectively communicating the associated risks to expectant parents can be challenging, especially for those with lower literacy levels.

To improve understanding of risk, it is recommended to present risk information as frequencies instead of percentages and to engage in discussions about the individual's preconceptions regarding their risk and the conditions being tested.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Communicating risk in prenatal genetic testing. Gates, EA.[2009]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7706578/

Impact of Emerging Technologies in Prenatal Genetic ... This review aims to provide a snapshot of prenatal genetic counseling in 2019, an overview of the use of prenatal diagnostic and screening tests.

2. gimopen.org gimopen.org/article/S2949-7744(24)00967-1/fulltext

Informal prenatal genetic screening education: What can ... The goal of this article is to explore what online education and decision support tools are freely available to patients about prenatal screening.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1744165X17301415

Genetic counselling, patient education, and informed ... Genetic information is typically complex and, especially in the context of prenatal screening for reproductive options, requires effective communication, ...

4. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/jgc4.1999

Evaluating genetic counseling session duration: A scoping ... On average, genetic counseling patient care time was a mean of 60 min (53 min median) for observational studies and control groups in experimental studies.

5. awspntest.apa.org awspntest.apa.org/doi/10.1111/ijn.13000

Counselling and education for prenatal screening ... Prenatal genetic counselling and education are more effective if provided from the first weeks of pregnancy. Decreasing anxiety, decisional ...

6. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK557702/

Prenatal Genetic Screening - StatPearls - NCBI Bookshelf - NIH Prenatal genetic screening evaluates the risk of a fetus having a specific genetic disorder, such as trisomy 21, 13, 18, and sex chromosome ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S2949774424009671

Informal prenatal genetic screening education: What can ... The goal of this article is to explore what online education and decision support tools are freely available to patients about prenatal screening.

8. acog.org acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/04/counseling-about-genetic-testing-and-communication-of-genetic-test-results

Counseling About Genetic Testing and Communication of ... A discussion about the potential risks and pitfalls of testing is particularly pertinent in the setting of genetic testing, especially with some of the newer ...