A follow up study of 164 couples to evaluate reproductive decision making two to three years after genetic counselling showed that 43% had problems making the reproductive decision. These couples (1) had experienced difficulty in the decision making process, (2) had doubts about the decision they had made, or (3) had been unable to make a decision. Using logistic regression analysis we identified the following factors as independently and significantly associated with problems in the decision making process: (1) no postcounselling relief, (2) anticipation of a high risk level, (3) relatives' disapproval of decision, (4) a decision against having children, and (5) the presence of an affected child. Interestingly, of the couples that decided to have children, 45% of those who were eligible for prenatal diagnosis experienced the decision making process as difficult compared with 23% of those for whom prenatal diagnosis was not available (p less than 0.05). Problems in the decision making process may become apparent after genetic counselling rather than in the course of it. We suggest a structured follow up three to six months after genetic counselling to identify couples that would benefit from additional supportive counselling.
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