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Purpose. Decisions regarding prenatal testing for Down syndrome are value laden and should reflect informed patient preferences. We explored the effect of an interactive computerized decision-assisting tool (“PT Tool”), which we have previously shown to increase knowledge and decrease decisional conflict, on women’s prior inclinations regarding prenatal testing in a randomized clinical trial.
Methods. 496 pregnant women were randomized to either PT Tool or the computerized version of California's educational pamphlet (control). Baseline testing inclinations were assessed prior to randomization and 1-2 weeks later by asking “If you were offered amniocentesis free of charge in your current pregnancy, would you choose to have it? with response options ranging from “definitely would” to “definitely would not.” Utilization was assessed at a 30 gestational week interview or via chart review.
Results. The overall rate of utilization of invasive testing (10%) did not differ between PT Tool viewers and controls among women aged < 35, to whom these tests are not routinely offered. At follow-up, inclination to undergo diagnostic testing was lower among women who viewed PT Tool (24% versus 33%, p <.01 ), suggesting that all else being equal, viewing PT Tool would attenuate the uptake rate of invasive testing in younger women if these tests were offered to them free of charge. When it came to utilization of invasive testing among women aged 35 and older, women in the control and PT Tool intervention groups also had almost identical invasive test rates (66%), after controlling for baseline inclination. However, an interaction between the experimental intervention and baseline invasive test inclinations was observed.
Use of invasive testing by baseline (pre-randomization) inclination, women ³ 35 years
| Intervention | Low/moderate inclination | High inclination | All women |
| Control | 29.2% | 94.9% | 66.4% |
| PT Tool | 44.8% | 84.3% | 66.3% |
Within the control group, baseline invasive testing inclinations were highly predictive of actual test behavior (r = .66), whereas among viewers of PT Tool this association was more moderate (r = .41). That is, women who viewed PT Tool were more likely to exhibit invasive testing utilization that was inconsistent with their baseline inclination, suggesting that PT Tool helped to change their minds (p=.03).
Conclusion. The significant interaction effect and lack of a main effect suggested that PT Tool is a useful and unbiased decision aid that helps women make informed choices about prenatal testing.
See more of Oral Concurrent Session A - Patient and Physician Behavior/Preferences 2
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)