研究生: |
梁艾琪 Liang, Ai-Chi |
---|---|
論文名稱: |
孕婦對產前唐氏症篩檢知情選擇之闡釋—Q方法之運用 Interpretations of Informed Choice in Antenatal Screening among Pregnant Women-A Q Methodology Study |
指導教授: |
施淑芳
Shih, Shu-Fang |
學位類別: |
碩士 Master |
系所名稱: |
健康促進與衛生教育學系 Department of Health Promotion and Health Education |
論文出版年: | 2017 |
畢業學年度: | 105 |
語文別: | 中文 |
論文頁數: | 117 |
中文關鍵詞: | 唐氏症篩檢 、知情選擇 、Q方法 、決策 、醫病共享決策 |
英文關鍵詞: | Antenatal Screening, Informed Choice, Q Methodology, Decision-making, Shared Decision Making |
DOI URL: | https://doi.org/10.6345/NTNU202202642 |
論文種類: | 學術論文 |
相關次數: | 點閱:161 下載:14 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
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。
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.
中文文獻
中央健康保險署(2017)。全民健康保險年報。臺北:中央健康保險署。
孔祥明(2001)。媳婦?女兒?妳媽?我媽?從誰是“自己人”看婆媳關係。本土心理學研究,(16),43-87。
台灣胎兒醫學全球資訊網(2009)。台灣胎兒醫學全球資訊網。2017年1月10日,取自http://www.fetalmedicine.org.tw/fetalmed/
禾馨婦產科(2016)。禾馨婦產科。2017年1月14日,取自http://www.dianthus.com.tw/
朱凱麟、楊佳鳳(2004)。遺傳疾病諮詢服務窗口─Down Syndrome。2016年6月7日,取自http://gene.hpa.gov.tw/index.php?mo=DiseasePaper&action=paper1_show&cate=Set1&csn=1&sn=103
行政院內政部統計處(2017)。內政統計通報。2017年8月19日,取自https://www.moi.gov.tw/stat/news_content.aspx?sn=12037
利翠珊(1997)。婚姻中親密關係的形成與發展。中華心理衛生學刊,10(4),101-128。
利翠珊(2002)。婆媳與母女:不同世代女性家庭經驗的觀點差異。女學學誌:婦女與性別研究,(13),179-218。doi:10.6255/jwgs.2002.13.179
吳俊杰、楊永盛、張庭榕(2009)。應用 Q 方法分析年輕消費者之產品設計鑑賞。設計學報,9(3)。
胡蓉、林金定(2009)。特殊需求學生主要照顧者壓力與健康相關生活品質相關性之研究。身心障礙研究季刊,7(2),132-143。
財團法人醫院評鑑暨醫療品質策進會(2016)。醫病共享決策簡介。2017年1月17日,取自http://www.patientsafety.mohw.gov.tw/Content/Messagess/Contents.aspx?SiteID=1&MmmID=710351317675351145
張文華(2014)。研發多模式寫作學科學課程教材促進科學教師學習之研究(科技部計畫編號:NSC101-2511-S003-017-MY3)。台北:國立臺灣師範大學科學教育研究所。
張文華、陳致成、楊婉姈、黃重慧(2008)。網際網路使用者對垃圾郵件的認知類型分析。科技管理學刊,13(2),61-94。
張惠玲、陳啟勳(2012)。中重度智能障礙者之主要照顧者壓力及生活品質之研究。台灣健康照顧研究學刊,(12),21-34。
章英華、杜素豪、廖培珊(2012)。台灣社會變遷基本調查計畫2011第六期第二次:家庭組(行政院國家科學委員會計畫編號:C00222_1 )。臺北:中央研究院社會學研究所。
陳玉華、伊慶春、呂玉瑕(2000)。婦女家庭地位之研究:以家庭決策模式爲例。臺灣社會學刊,(24),1-58。
陳俐文(2014)。大學生對應用「電子徽章」於「翻轉學堂」之認知(科技部計畫編號MOST103-2511-S216-002 )。台北:中華大學科技管理學系(所)。
黃旭男、張維容(2014)。病人對醫師與醫院信任、滿意與忠誠之關係。健康管理學刊,12(1),1-20。
楊佳鳳(2016)。國民健康署認證通過之遺傳諮詢中心。2017年1月17日,取自https://gene.hpa.gov.tw/index.php?module=bhp&action=list&tkind=4
楊嘉玲、陳美伶(2001)。Q研究法之簡介。長庚護理,12(2),144-153。
溫家青(2008)。婆媳角色期待的差異性研究(未出版之碩士論文)。國立暨南國際大學,南投縣。
廖智倩、闕月清(2006)。課程目標認同傾向與教學計畫之探討:以“健康與體育”學習領域第一學習階段為例。大專體育學刊,8(3),27-37。
熊賢關(1998)。儒家傳統中的婦女觀。哲學雜誌,24,100-117。
臺北市衛生局(2017)。孕婦唐氏症篩檢須知。2017年1月10日取自http://health.gov.taipei/Default.aspx?tabid=626
劉仲矩(2010)。網路衝突成因認知類型之研究。Electronic Commerce Studies,8(3),299-322。
劉仲矩(2014)。購物網站網頁美學使用者知覺類型之初探。Electronic Commerce Studies,12(4),377-399。
劉仲矩、黃湘凌(2014)。以 Q 方法探討智慧型手機使用者反應類型之研究。Electronic Commerce Studies,12(1),27-49。
劉仲矩、廖子寧(2015)。Ubike使用者知覺價值類型分析。觀光與休閒管理期刊,3(2),43-57。doi:10.6510/jtlm.3(2).04。
劉毓秀(2005)。婦女政策白皮書。2017年8月17日,取自http://www.iwomenweb.org.tw/cp.aspx?n=5654361B474B8EFF
蔡甫昌、張至寧、楊智超、胡務亮(2008)。臺灣遺傳檢驗與咨詢施行之現況分析與倫理反省。醫學教育,12(3),44-63。
蔡甫昌、楊尚儒、張至寧、胡務亮、楊智超(2010)。遺傳檢測倫理議題及遺傳諮詢倫理準則。台灣醫學,14(6),658-671。doi:10.6320/fjm.2010.14(6).09
衛生福利部國民健康署(2015)。國民健康署年報。臺北市:衛生福利部國民健康署。
衛生福利部國民健康署(2016a)。孕婦健康手冊。臺中市:衛生福利部國民健康署。
衛生福利部國民健康署(2016b)。家庭與生育調查報告。臺北市:衛生福利部國民健康署。
盧欽銘(1989)。Q技術。台北:東華書局。
賴世芬、鄭婉伶(2014)。以Q方法探討國民中小學校長對健康促進學校國際認證指標看法之研究。健康生活與成功老化學刊,6(1),10-24。
醫病共享決策影片─產科工作小組(2016)。如何選擇唐氏症的篩檢。2017年5月13日取自http://sdm.patientsafety.mohw.gov.tw/AssistTool/AccessibilityForm?sn=24&tid=6698F06FFFE9936C
羅文輝(1986)。 Q方法的理論與應用。民意學術專刊,(37),45-71。
嚴嘉楓、林金定、羅慶徽、李志偉、吳佳玲(2004)。智慧障礙者人口學特徵與障礙成因初探:以台灣官方身心障礙人口資料檔調查分析。台灣家庭醫學雜誌,14(4),173-183。
英文文獻
Agency for Healthcare Research and Quality. (2013). NSGC practice guideline: prenatal screening and diagnostic testing options for chromosome aneuploidy. Retreved July 10, 2017, from https://www.guideline.gov/summaries/summary/43950/nsgc-practice-guideline-prenatal-screening-and-diagnostic-testing-options-for-chromosome-aneuploidy
Ahmed, S., Bryant, L., & Hewison, J. (2007). ‘Balance’ is in the Eye of the Beholder: Providing Information to Support Informed Choices in Antenatal Screening via Antenatal Screening Web Resource. Health Expectations, 10(4), 309-320. doi:10.1111/j.1369-7625.2007.00455.x
Ahmed, S., Bryant, L. D., & Cole, P. (2013). Midwives' Perceptions of Their Role as Facilitators of Informed Choice in Antenatal Screening. Midwifery, 29(7), 745-750. doi:http://dx.doi.org/10.1016/j.midw.2012.07.006
Ahmed, S., Bryant, L. D., Tizro, Z., & Shickle, D. (2012). Interpretations of Informed Choice in Antenatal Screening: A Cross-cultural, Q-methodology Study. Social Science & Medicine, 74(7), 997-1004. doi:http://dx.doi.org/10.1016/j.socscimed.2011.12.021
Ahmed, S., Bryant, L. D., Tizro, Z., & Shickle, D. (2014). Is Advice Incompatible with Autonomous Informed Choice? Women’s Perceptions of Advice in the Context of Antenatal Screening: A Qualitative Study. Health Expectations, 17(4), 555-564. doi:10.1111/j.1369-7625.2012.00784.x
American College of Obstetricians and Gynecologists. (2012). Committee Opinion No. 545: Noninvasive Prenatal Testing for Fetal Aneuploidy. Obstetrics & Gynecology, 120(6), 1532-1534. doi:10.1097/01.AOG.0000423819.85283.f4
Arabul, M., Kandemir, A., Celik, M., & Ünsal, B. (2013). Impact of Video Information before Unsedated Upper Gastrointestinal Endoscopy on Patient Satisfaction and Anxiety: A Prospective Randomized Trial. Przegląd Gastroenterologiczny, 1(1), 44-49.
Armeana, Florina, PatriciuCătălin, Alexandru, Cosmin, Florin, . . . Alexandru, G. (2016). The Impact of Relaxation Technique and Pre-operative Psychological Counselling on Pain, Analgesic Consumption and Psychological Symptoms on Patients Scheduled for Breast Cancer Surgery – A Randomized Clinical Study. Journal of Evidence-Based Psychotherapies, 16(2), 205-220.
Beauchamp, T., L, & Childress, J., F. (2013). Principles of Biomedical Ethics, 7th edn. New York, NY: Oxford University Press.
Bekker, H., Modell, M., Denniss, G., Silver, A., Mathew, C., Bobrow, M., & Marteau, T. (1993). Uptake of Cystic Fibrosis Testing in Primary Care: Supply Push or Demand Pull? British Medical Journal, 306(6892), 1584-1586. doi:10.1136/bmj.306.6892.1584
Bekker, H. L., Hewison, J., & Thornton, J. G. (2004). Applying decision analysis to facilitate informed decision making about prenatal diagnosis for Down syndrome: a randomised controlled trial. Prenatal Diagnosis, 24(4), 265-275. doi:10.1002/pd.851
Belkora, J., Volz, S., Loth, M., Teng, A., Zarin-Pass, M., Moore, D., & Esserman, L. (2015). Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program. BMC Health Services Research, 15, 209. doi:10.1186/s12913-015-0872-6
Belkora, J. K., Miller, M. F., Dougherty, K., Gayer, C., Golant, M., & Buzaglo, J. S. (2015). The need for decision and communication aids: a survey of breast cancer survivors. J Community Support Oncol, 13(3), 104-112. doi:10.12788/jcso.0116
Block, J. (1961). The Q-sort Method in Personality Assessment and Psychiatric Research. Sprngfield, IL: Charles C Thomas.
Blumenthal-Barby, J. S. (2017). ‘That’s the doctor’s job’: Overcoming patient reluctance to be involved in medical decision making. Patient Education and Counseling, 100(1), 14-17. doi:http://dx.doi.org/10.1016/j.pec.2016.07.010
Bolland, J. M. (1985). The Search for Structure: An Alternative to Force Q-sort Technique. Political Methodology, 11, 91-107.
Boulet, S. L., Molinari, N.-A., Grosse, S. D., Honein, M. A., & Correa-Villaseñor, A. (2008). Health Care Expenditures for Infants and Young Children with Down Syndrome in a Privately Insured Population. The Journal of Pediatrics, 153(2), 241-246. doi:http://dx.doi.org/10.1016/j.jpeds.2008.02.046
Bryant, L. D., Ahmed, S., Ahmed, M., Jafri, H., & Raashid, Y. (2011). ‘All Is Done by Allah’. Understandings of Down Syndrome and Prenatal Testing in Pakistan. Social Science & Medicine, 72(8), 1393-1399. doi:http://dx.doi.org/10.1016/j.socscimed.2011.02.036
Buehner, T. M. (2011). College Student Preferences for Trendy versus Classic Typefaces. Operant Subjectivity, 35(1), 1-36.
Chang, Y. W., Chang, C. M., Sung, P. L., Yang, M. J., Li, W. H., Li, H. Y., . . . Wang, P. H. (2012). An Overview of a 30-year Experience with Amniocentesis in a Single Tertiary Medical Center in Taiwan. Taiwanese Journal of Obstetrics and Gynecology, 51(2), 206-211. doi:10.1016/j.tjog.2012.04.007
Charles, C., Gafni, A., & Whelan, T. (1997). Shared Decision-making in the Medical Encounter: What Does It Mean? (Or It Takes at Least Two to Tango). Social Science & Medicine, 44(5), 681-692. doi:http://dx.doi.org/10.1016/S0277-9536(96)00221-3
Chen, S.-F., Huang, S.-F., Lu, L.-T., Wang, M.-C., Liao, J.-Y., & Guo, J.-L. (2016). Patterns of Perspectives on Fall-prevention Beliefs by Community-dwelling Older Adults: A Q Method Investigation BMC Geriatrics, 16(132), 1-10.
Chiang, H. H., Chao, Y. M., & Yuh, Y. S. (2006). Informed Choice of Pregnant Women in Prenatal Screening Tests for Down's Syndrome. Journal of Medical Ethics, 32(5), 273-277. doi:10.1136/jme.2005.012385
Christman, J. (2015). Autonomy in Moral and Political Philosophy. Stanford Encyclopedia of Philosophy. Retrieved January 20, 2017 from https://plato.stanford.edu/entries/autonomy-moral/
Coogan, J., & Herrington, N. (2011). Q Methodology: An Overview. RESEARCH IN SECONDARY TEACHER EDUCATION, 1(2), 24-28.
Deber, R. B., Kraetschmer, N., & Irvine, J. (1996). What Role Do Patients Wish to Play in Treatment Decision Making? Archives of Internal Medicine, 156(13), 1414-1420. doi:10.1001/archinte.1996.00440120070006
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization. (2013). A Handbook for Building Skills: Counselling for Maternal and Newborn Health Care. Switzerland: World Health Organization.
Durning, D. W., & Brown, S. R. (2006). Q Methodology and Decision Making. In G. Morcol (Ed.), Handbook of Decision Making. Boca Raton: CRC Press.
Entwistle, V. A., Sheldon, T. A., Sowden, A., & Watt, I. S. (1998). Evidence-Informed Patient Choice: Practical Issues of Involving Patients in Decisions About Health Care Technologies. International Journal of Technology Assessment in Health Care, 14(2), 212-225. doi:10.1017/S0266462300012204
Gustafson, B., Hanley, M., & Popovich, M. (2008). Women's Perceptions of Female Body Shapes and Celebrity Models: The Dove Firming Cream Advertising Revisited. Paper presented at the American Academy of Advertising. Conference. Proceedings (Online).
Haeusler, M., Nelen, V., Jacquemyn, Y., Odak, L., Barisic, I., Christiansen, M., . . . Boyd, P. (2010). Special Report: Prenatal Screening Policies. Northern Ireland: EUROCAT Central Registry.
Hamann, J., & Heres, S. (2014). Adapting Shared Decision Making for Individuals With Severe Mental Illness. Psychiatric Services, 65(12), 1483-1486. doi:10.1176/appi.ps.201400307
Department of Health. (2008). NICE guidance on the routine care of healthy pregnant women (2nd ed). London: National Collaborating Centre for Women’s and Children’s Health.
Hewison, J., Green, J. M., Ahmed, S., Cuckle, H. S., Hirst, J., Hucknall, C., & Thornton, J. G. (2007). Attitudes to Prenatal Testing and Termination of Pregnancy for Fetal Abnormality: A Comparison of White and Pakistani Women in the UK. Prenatal Diagnosis, 27(5), 419-430. doi:10.1002/pd.1701
Hoffmann, T. C., Légaré, F., Simmons, M. B., McNamara, K., McCaffery, K., Trevena, L. J., . . . Del Mar, C. B. (2014). Shared Decision Making: What Do Clinicians Need to Know and Why Should They Bother. Medical Journal of Australia, 201(1), 35-39.
Hoge, S. K., & Appelbaum, P. S. (2012). Ethics and neuropsychiatric genetics: a review of major issues. International Journal of Neuropsychopharmacology, 15(10), 1547-1557. doi:10.1017/S1461145711001982
Horey, D., Kealy, M., Davey, M. A., Small, R., & Crowther, C. A. (2013). Interventions for Supporting Pregnant Women's Decision‐making about Mode of Birth after a Caesarean. The Cochrane Library.
Huang, C.-M., Hung, W.-S., Lai, J.-N., Kao, Y.-H., Wang, C.-L., & Guo, J.-L. (2016). Maternity Staff Perspectives Regarding Resource Demands of Breastfeeding Supportive Practices in Accordance with the Baby-Friendly Hospital Initiative Accreditation: A Q methodology Approach. Journal of Advanced Nursing, 72(6), 1301-1312. doi:10.1111/jan.12928
Hung, W.-J., Lin, L.-P., Wu, C.-L., & Lin, J.-D. (2011). Cost of Hospitalization and Length of Stay in People with Down Syndrome: Evidence from A National Hospital Discharge Claims Database. Research in Developmental Disabilities, 32(5), 1709-1713. doi:http://dx.doi.org/10.1016/j.ridd.2011.02.024
Hutchinson, R. H., & Barrie, J. L. (2015). The Effects of Shared Decision Making in the Conservative Management of Stable Ankle Fractures. Injury, 46(6), 1116-1118. doi:http://dx.doi.org/10.1016/j.injury.2015.01.013
Kahneman D, S. P., Tversky A. . (1982). Judgment under uncertainty heuristics and biases. Cambridge: Cambridge University.
Karim, K. (2001). Q Methodology - Advantages and Disadvantages of This Research Method. Journal of Community Nursing, 15(4), 8-10.
Kerlinger, F. N. (1973). Foundation of Behavioral Research. New York: Holt, Rinehart and Winston, Inc.
Kim, J. H., Kim, B. I., & Kim, J. K. (2003). Olfactory Factors in Aroma Uses. Journal of Human Subjectivity, 1(2), 157-176.
Kobelka, C., Mattman, A., & Langlois, S. (2009). An Evaluation of the Decision-making Process Regarding Amniocentesis Following a Screen-positive Maternal Serum Screen Result. Prenatal Diagnosis, 29(5), 514-519. doi:10.1002/pd.2235
Korenberg, J. R., Chen, X. N., Schipper, R., Sun, Z., Gonsky, R., Gerwehr, S., . . . et al. (1994). Down Syndrome Phenotypes: the Consequences of Chromosomal Imbalance. Proceedings of the National Academy of Sciences, 91(11), 4997-5001.
Légaré, F., St-Jacques, S., Gagnon, S., Njoya, M., Brisson, M., Frémont, P., & Rousseau, F. (2011). Prenatal Screening for Down Syndrome: A Survey of Willingness in Women and Family Physicians to Engage in Shared Decision-making. Prenatal Diagnosis, 31(4), 319-326. doi:10.1002/pd.2624
Lau, J. Y. C., Yi, H., & Ahmed, S. (2016). Decision-making for Non-invasive Prenatal Testing for Down Syndrome: Hong Kong Chinese Women's Preferences for Individual vs Relational Autonomy. Clinical Genetics, 89(5), 550-556. doi:10.1111/cge.12743
Lee, S. C. (2015). Intimacy and Family Consent: A Confucian Ideal. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 40(4), 418-436. doi:10.1093/jmp/jhv015
Lewis, C., Silcock, C., & Chitty, L. S. (2013). Non-Invasive Prenatal Testing for Down's Syndrome: Pregnant Women's Views and Likely Uptake. Public Health Genomics, 16(5), 223-232.
Li, W.-H., Wang, P.-H., Chuang, C.-M., Chang, Y.-W., Yang, M.-J., Chen, C.-Y., . . . Yen, M.-S. (2015). Noninvasive Prenatal Testing for Fetal Trisomy in a Mixed Risk Factors Pregnancy Population. Taiwanese Journal of Obstetrics and Gynecology, 54(2), 122-125. doi:http://dx.doi.org/10.1016/j.tjog.2015.02.001
Lin, M.-L., Huang, C.-T., & Chen, C.-H. (2016). Reasons for family involvement in elective surgical decision-making in Taiwan: a qualitative study. Journal of Clinical Nursing, 1969-1977. doi:10.1111/jocn.13600
Lin, M.-L., Kan, W.-M., & Chen, C.-H. (2012). Patients' Perceptions and Expectations of Family Participation in the Informed Consent Process of Elective Surgery in Taiwan. Asian Nursing Research, 6(2), 55-59. doi:10.1016/j.anr.2012.05.001
Mackenzie C, S. N. (2000). Relational Autonomy: Feminist Perspectives on Autonomy, Agency and the Social Self. New York, NY: Oxford University Press.
Marteau, T. M., Dormandy, E., & Michie, S. (2001). A Measure of Informed Choice. Health Expectations, 4, 99-108.
McKeown, B., & Thomas, D. B. (2013). Q Methodology. USA: SAGE Publications, Inc.
Mennuti, M. T., & Driscoll, D. A. (2003). Screening for Down's Syndrome-too Many Choices? The New England Journal of Medicine, 349(15), 1471-1473.
National Down Syndrome Society. (2012). What Is Down Syndrome? Retrieved January 19, 2017, from http://www.ndss.org/Down-Syndrome/What-Is-Down-Syndrome/
National Health Service. (2012). Shared Decision Making. Retrieved July 16,2016 from http://sdm.rightcare.nhs.uk/about/using-a-decision-aid/
National Institute for Health and Care Excellence. (2016). NICE Guideline. London: National Institute for Health and Care Excellence.
National Screening Unit. (2012). Antenatal Screening for Down Syndrome and Other Conditions: Guidelines for Health Practitioners. Wellington: Ministry of Health.
O'connor, & O'brien-Pallas. (1989). Decisional Conflicts. Toronto: Mosby.
World Health Organization. (2006). Medical Genetic Services in Developing Countries: the Ethical, Legal and Social Implications of Genetic Testing and Screening. Retrieved January 20, 2017 from Switzerland: http://www.who.int/genomics/publications/en/index1.html
Oshana, M. (2006). Personal Autonomy in Society. Hampshire, UK: Ashgate.
Parker, J. L., Regan, J. F., & Petroski, J. (2014). Beneficiary Activation in the Medicare Population. Medicare & Medicaid Research Review, 4(4), mmrr2014-2004-2004-b2002. doi:10.5600/mmrr.004.04.b02
Robbins, P., & Kreuger, R. (2000). Beyond Bia? The Promise and Limits of Q Method in Human Geography. The Professional Geographer, 52(4), 636-648.
Ryan, R. M., & Deci, E. L. (2006). Self‐Regulation and the Problem of Human Autonomy: Does Psychology Need Choice, Self‐Determination, and Will? J Pers, 74(6), 1557-1586. doi:10.1111/j.1467-6494.2006.00420.x
Schoonen, M., Wildschut, H., Essink-Bot, M.-L., Peters, I., Steegers, E., & de Koning, H. (2012). The Provision of Information and Informed Decision-making on Prenatal Screening for Down Syndrome: A Questionnaire- and Register-based Survey in a Non-selected Population. Patient Education and Counseling, 87(3), 351-359. doi:http://dx.doi.org/10.1016/j.pec.2011.10.001
Shaw, S.-W., Hsu, J.-J., Lee, C.-N., Hsiao, C.-H., Chen, C.-P., Hsieh, T. s.-T. a., & Cheng, P.-J. (2008). First- and Second-trimester Down Syndrome Screening: Current Strategies and Clinical Guidelines. Taiwanese Journal of Obstetrics and Gynecology, 47(2), 157-162. doi:http://dx.doi.org/10.1016/S1028-4559(08)60073-X
Shaw, S. W. S., Chen, C.-P., & Cheng, P.-J. (2013). From Down Syndrome Screening to Noninvasive Prenatal Testing: 20 years' Experience in Taiwan. Taiwanese Journal of Obstetrics and Gynecology, 52(4), 470-474. doi:http://dx.doi.org/10.1016/j.tjog.2013.10.003
Shaw, S. W. S., Lin, S.-Y., Lin, C.-H., Su, Y.-N., Cheng, P.-J., Lee, C.-N., & Chen, C.-P. (2010). Second-trimester Maternal Serum Quadruple Test for Down Syndrome Screening: A Taiwanese Population-based Study. Taiwanese Journal of Obstetrics and Gynecology, 49(1), 30-34. doi:http://dx.doi.org/10.1016/S1028-4559(10)60005-8
Shepherd, H. L., Barratt, A., Trevena, L. J., McGeechan, K., Carey, K., Epstein, R. M., . . . Tattersall, M. H. N. (2011). Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial. Patient Education and Counseling, 84(3), 379-385. doi:10.1016/j.pec.2011.07.022
Shultz, M. M. (1982). The Ethical and Legal Implications of the Requirements for Informed Consent, America: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.
Shultz, M. M. (1985). From Informed Consent to Patient Choice: A New Protected Interest. Yale Law J, 95(2), 219-299.
Simons, J. (2013). An Introduction to Q Methodology. Nurse Res, 20(3), 28-32. doi:10.7748/nr2013.01.20.3.28.c9494
Skjøth, M. M., Hansen, H. P., Draborg, E., Pedersen, C. D., Lamont, R. F., & Jørgensen, J. S. (2015). Informed Choice for Participation in Down Syndrome Screening: Development and Content of a Web-Based Decision Aid. JMIR Research Protocols, 4(3), e113. doi:10.2196/resprot.4291
Somerstein, R. (2014). The Taste Test: Applying Q Methodology to Aesthetic Preference. Operant Subjectivity, 37(1-2), 72-96.
Spearman, C. (1927). The Abilities of Man. New York, NY: Macmillan.
Stephenson, W. (1935). Technique of Factor Analysis. Nature, 136, 297. doi:10.1038/136297b0
Stephenson, W. (1936). A New Appilication of Correlation to Averages. British Journal of Educational Psychology, 6, 43-57.
Stephenson, W. (1953). The Study of Behaviors: Q-technique and its Methodology. Chicago: University of Chicago Press.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. (2015). Prenatal Screening and Diagnosis of Chromosomal and Genetic Abnormalities in the Fetus in Pregnancy. New Zealand: Human Genetics Society of Auatralasia.
Thomas, G. H. (1935). On Complete Families of Correlation Coefficients, and Their Tendency to Zero Tetrad-differences: Including a Statement of the Sampling Theory of Abilities. British Journal of Psychology, 26, 63-92.
Tsai, D. (2005). The bioethical principles and Confucius' moral philosophy. Journal of Medical Ethics, 31(3), 159-163. doi:10.1136/jme.2002.002113
Tsai, D. F. (2006). Eye on religion: confucianism, autonomy and patient care. South Med J, 99(6), 685-687. doi:10.1097/01.smj.0000222398.48333.04
Ubel, P. A. (2012). Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. San Francisco: HarperOne.
van den Heuvel, A., Chitty, L., Dormandy, E., Newson, A., Attwood, S., Ma, R., . . . Marteau, T. M. (2009). Is informed choice in prenatal testing universally valued? A population-based survey in Europe and Asia. BJOG: An International Journal of Obstetrics & Gynaecology, 116(7), 880-885. doi:10.1111/j.1471-0528.2009.02174.x
van den Heuvel, A., & Marteau, T. M. (2008). Cultural variation in values attached to informed choice in the context of prenatal diagnosis. Seminars in Fetal and Neonatal Medicine, 13(2), 99-102. doi:http://dx.doi.org/10.1016/j.siny.2007.12.010
Watts, S., & Stenner, P. (2005). Doing Q Methodology: Theory, Method and Interpretation. Qualitative Research in Psychology, 2, 67-91.
Wertz, D. C., & Fletcher, J. C. (2012). Genetics and ethics in global perspective (Vol. 17): Springer Science & Business Media.
Wertz, D. C., Fletcher, J. C., & Berg, K. (2006). Review of Ethical Issues in Medical Genetics Geneva, Switzerland: World Health Organization.
Wilson, R. M. (2000). Screening for Breast and Cervical Cancer as a Common Cause for Litigation. BMJ : British Medical Journal, 320(7246), 1352. doi:http://dx.doi.org/10.1136/bmj.320.7246.1352
Wolf, A. (2013). Wellbeing for Public Policy: Roles for Q Methodology. Operant Subjectivity, 36(3), 203-226.