IS THERE A NEED FOR A PATIENT DECISION AID FOR PRENATAL SCREENING?: PRENATAL PATIENTS' REPORTS ABOUT THEIR DECISION PROCESS

Purpose: The American Congress of Obstetrics and Gynecology recommends offering prenatal screening to all pregnant women. The concept of using screening tests as tools for risk assessment is time-consuming for providers to explain and difficult for patients to understand.  The purpose of this study was to assess whether women felt informed about prenatal screening, if their stated values matched their screening choice, and if they had any regret about their choice.

Method: At the time of their 28-32 week prenatal visit, women completed a questionnaire about their screening choice.  Measures included: decisional conflict (4-item SURE scale), value scores (1: Not important – 5: Very important), and regret (5-item Regret scale).

Result:   188 women returned completed questionnaires,  57% had been screened.   Most felt their provider reviewed all their options (89%), that they knew enough about the pros and cons of screening (93%), and that they were clear about the risks and benefits that mattered most to them (92%). The majority (88%) felt they made a wise screening decision, while only (2%) felt strongly their choice did them harm.  However, a substantial proportion of women that did NOT have screening (34%) felt it was important or very important to know whether they were at increased risk with 10% wanting to know for sure whether their baby had Down syndrome.  A subset (5%) were unsure if they had screening. Of the women who were screened, 5% were unsure of their results. 

Conclusion: Although most women reported they felt informed about prenatal screening without regrets about their decision, this study indicates that some patients are making choices that appear discordant with what is important to them. In addition, some are not aware of whether they were screened or the results.  These findings suggest that some women are not making informed, values based decisions. We plan to develop a video DA to help women understand the elective nature of prenatal screening and to consider what is important to them in making this decision.