VALUES-CONSISTENT DECISIONS WITH USE OF A PRENATAL TESTING DECISION SUPPORT GUIDE

Purpose: We previously conducted a randomized trial of an “informed free choice” approach to prenatal testing. Women who were randomized to view a decision support guide were less likely to undergo diagnostic testing and more likely to forego testing (screening and/or diagnostic) altogether than women in the control group. 10 values clarification questions were included in the decision guide; the purpose of this analysis was to determine whether responses to these questions were associated with subsequent testing decisions.

Method: We conducted a secondary analysis of data from the 281 participants who used the guide and worked through the values clarification exercises. We compared the mean response (5-point scale) on each items across three testing strategies chosen by these women, controlling for recruitment site, age, parity, education, relationship status, literacy and numeracy.

Result: We found significant differences across testing strategy group on 6 of the 10 items; the ordering of all the mean scores was consistent with the choices these women made.

Values Clarification Questions (mean±SE)	No tests (n=74)	Screening tests only (n=191)	Diagnostic testing) (n=16)	p- value
How important to you is knowing whether or not your baby will be born with a birth defect such as Down syndrome? (Higher score=more important)	3.64 (±0.17)	4.46 (±0.14)	4.71 (±0.31)	<.0001
Would you choose to have a diagnostic test that would tell you or sure whether or not your fetus has Down syndrome, even if it could cause a miscarriage? (Higher score=greater inclination)	2.16 (±0.17)	2.67 (±0.14)	4.37 (±0.31)	<.0001
Which would be worse for you, having a child with Down syndrome or having a miscarriage caused by a prenatal test? (Higher score=miscarriage worse)	3.55 (±0.16)	2.98 (±0.13)	2.22 (±0.29)	<.0001
How important is it to you to avoid a false positive screening result?	4.28 (±0.20)	3.92 (±0.13)	4.60 (±0.28)	.022
How important to you is knowing FOR SURE whether or not your fetus has Down syndrome?	3.75 (±0.24)	3.61 (±0.16)	4.99 (±0.34)	.0002
If you found out that your fetus had Down syndrome, do you think you would continue your pregnancy or do you think you would have an abortion? (Higher score=greater inclination to terminate)	2.33 (±0.18)	2.85 (±0.14)	3.68 (±0.32)	.0002

Conclusion: Our prenatal testing decision support guide helped women make choices consistent with their values.