18 y/o Hispanic female, G1P0, 19 weeks GA. She was advised via telephone of results of penta screen for NTD, Trisomy 18, Trisomy 21 screening. She presents in clinic with her boyfriend, mother, and sister--all in acute distress. Mother of patient does most of the talking. She reports that the patient was advised by a nurse that the test was screened positive for Downs and Edwards syndromes. They are here to get more information and to find out what to do next.
The NP seeing the family explains that the information they have is incorrect. She explains that the screen came back positive for possible neural tube defect, but tests for Trisomy 18 and 21 were negative. She discussed the chances that this pregnancy/fetus might be affected by neural tube problems, she explains what the range of possible malformations are, and further explains what happens next. The information includes the chances that this is a false positive, that this is a screening only. The patient's risk factors are also included in partial reassurance. The family, while still anxious, is able to process the information given, clearly able to state the next course of action, and verbalize understanding of the condition that the screeining test indicated.
In summary: The patient was given the wrong test results. She either was not given sufficient counseling prior to testing or was not in complete understanding of the information given. This may have been a function of either her age, maturity, and the care and preparation of the provider doing the consent prior to testing. Reporting of test results of this nature is best handled in person, not over the phone. Having support persons available was helpful.
I chose this case because it was like watching the Hispanic vesion of my daughter and I, and it really showed me that more care and sensitivity needs to be shown in ordering, consenting, and reporting these tests. No matter how careful the person is reporting these results, all the family hears is that something is wrong with their baby. It took 20 minutes just to calm this family down enough for them to be able to truly process the information that was being presented by the NP in person, in a vary calm, very clear, very concise manner.