Amniocentesis due to advanced maternal age: The role of marital intimacy in couples’ decision-making process

Due to the risk of fetal anomaly, pregnant women of advanced maternal age are given the option to undergo amniocentesis. In our study we aimed to describe couples’ decision-making process regarding amniocentesis, and assess whether it is influenced by marital intimacy and men’s participation in genetic counseling. During pregnancy, 112 couples answered the Personal Assessment of Intimacy in Relationships questionnaire and scales regarding the decision to undergo amniocentesis. Most couples shared and reached an agreement regarding this decision. Higher levels of marital engagement and communication, but not men’s participation, were associated with higher agreement, influence, and decision-sharing. Clinical implications are discussed

Genetics workforce: distribution of genetics services and challenges to health care in California

PurposeAccess to genetics health-care services is often complicated by the distance to hospitals, workforce shortages, and insurance coverage. Despite technological advances and decreasing costs of genetic sequencing, the benefits of personalized medicine may be inaccessible to many patients. To assess potential disparities in care, we examined the genetics workforce in California and geographical issues that people encounter in seeking care.MethodsData on all board-certified genetics providers were analyzed including medical geneticists (MGs) and genetic counselors (GCs) in California. To assess distance traveled for care, we computed the distance patients traveled for n = 288 visits to University of California-San Francisco (UCSF) Medical Genetics. We performed geographic optimization to minimize the distance to genetics providers.ResultsThe provider-to-patient ratio in California is 1:330,000 for MGs, 1:100,000 for GCs, and 1:1,520,000 for biochemical MGs. Genetics providers are concentrated in major metropolitan areas in California. People travel up to 386 miles for genetics care within the state (mean = 76.6 miles).ConclusionThere are substantial geographic barriers to genetics care that could increase disparities. Our findings highlight a challenging genetics workforce shortage. The shortage may be even greater due to care subspecialization or lack of full-time equivalency and staffing. We are currently promoting efforts to increase remote health-care options, training, and modified models of care