Considering medical risk information and communicating values: A mixed-method study of women’s choice in prenatal testing

Abstract

IntroductionNowadays, an important decision for pregnant women is whether to undergo prenatal testing for aneuploidies and which tests to uptake. We investigate the factors influencing women’s choices between non-invasive prenatal testing (NIPT) and invasive prenatal tests in pregnancies with elevated a priori risk of fetal aneuploidies.MethodologyThis is a mixed-method study. We used medical data (1st Jan 2015-31st Dec 2015) about women participating in further testing at Fetomaternal Medical Center at Helsinki University Hospital and employed Chi-square tests and ANOVA to compare the groups of women choosing different methods. Multinomial logistic regressions revealed the significant clinical factors influencing women’s choice. We explored the underlying values, beliefs, attitudes and other psychosocial factors that affect women’s choice by interviewing women with the Theory of Planned Behavior framework. The semi-structured interview data were processed by thematic analysis.ResultsStatistical data indicated that gestational age and counseling day were strong factors influencing women’s choice. Interview data revealed that women’s values and moral principles on pregnancy and childbirth chiefly determined the choices. Behavioral beliefs (e.g. safety and accuracy) and perceived choice control (e.g. easiness, rapidness and convenience) were also important and the major trade-offs happened between these constructs.DiscussionValues are the determinants of women’s choice. Service availability and convenience are strong factors. Medical risk status in this choice context is not highly influential. Choice aids can be developed by helping women to identify their leading values in prenatal testing and by providing lists of value-matching test options and attributes.

Facilitating informed choice about non-invasive prenatal testing (NIPT): a systematic review and qualitative meta-synthesis of women’s experiences

“…Many women understood that NIPT has high specificity and sensitivity [24, 25, 27, 30, 31, 60, 63, 66, 68, 70, 72], although there was some disagreement among them about the comparative accuracies of NIPT and traditional prenatal testing modalities [25–27, 30, 70]. A minority of women believed NIPT to be the most accurate prenatal testing option, but most identified invasive testing as being most definitive [25, 27, 30, 70].…”

Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening

“…Thus, mapping our findings onto the Theory of Planned Behavior (TPB) contributes to advancing novel, tailored family interventions promoting cancer predisposition cascade genetic testing for BRCA . This theoretical contribution towards developing complex interventions promoting cascade screening is further supported by the demonstrated utility of the TPB in breast cancer and genetic counseling [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…One theory, the Theory of Planned Behavior (TPB) [ 24 ], has been effectively used in the context of breast cancer to describe a wide range of cancer-related behaviors including screening/mammography [ 25 ], risk-reducing surgeries [ 26 , 27 ], lymphedema risk reduction activities [ 28 ], adherence to adjuvant endocrine therapies [ 29 ], as well as contacting potentially at-risk relatives [ 30 ]. Similarly, the TPB has been employed in the field of genetic counseling [ 31 ] to better understand and predict behaviors around prenatal genetic testing [ 32 ] and expanded carrier screening [ 33 ].…”

Benefits, challenges and ethical principles associated with implementing noninvasive prenatal testing: a Delphi study

“…Our findings thus resonate with the literature, wherein concerns are expressed as to the potential impact on informed decision-making in terms of implementing noninvasive prenatal testing as "just another blood test" [23][24][25][26] and advocating the active promotion of women's reproductive autonomy. [27][28][29][30] In addition to protecting free choice, participants underscored the need to ensure the appropriate conditions for evidence-based decision-making. In this respect, they highlighted the difficulty of ensuring the adequate education of health professionals about new prenatal testing technologies and their potential ethical and societal implications.…”