The role of attitudes towards the targets of behaviour in predicting and informing prenatal testing choices

Abstract

Research considering the role of attitudes in prenatal testing choices has commonly focused on the relationship between the attitude towards undergoing testing and actual testing behaviour. In contrast, this study focused on the relationship between testing behaviour and attitudes towards the targets of the behaviour (in this case people with Down syndrome (DS) and having a baby with DS). A cross-sectional, prospective survey of 197 pregnant women measured attitudes towards the targets of prenatal testing along with intentions to use screening and diagnostic testing, and termination of an affected pregnancy. Screening uptake was established via patient records. Although attitudes towards DS and having a baby with DS were significantly associated with screening uptake and testing and termination intentions, unfavourable attitudes were better than favourable ones at predicting these outcomes. For example, in the quartile of women with the "most favourable" attitude towards people with DS 67% used screening although only 8% said they would terminate an affected pregnancy. Qualitative data suggested that not all women considered personal attitudes towards DS to be relevant to their screening decisions. This finding has implications for the way in which informed choice is currently understood and measured in the prenatal testing context.

Attitudinal ambivalence towards Down’s syndrome and uncertainty in prenatal testing and termination intentions

“…Those who used screening and (hypothetically) intended to use amniocentesis and termination held less-positive attitudes towards the condition than did those who did not use/did not intend to use them. However, while attitudes towards people with DS were good predictors of intentions to terminate for the condition, they were only weak predictors of screening behaviour (Bryant et al, 2010). Qualitative data revealed that women did not consider their attitudes towards DS as salient to their screening decision, only to decisions about diagnostic testing or termination; it is also possible that attitudinal ambivalence may have been partly responsible for the weak relationship.…”

“…In this study, a higher level of ambivalent beliefs about parenting a child with DS was associated with having a screening test, but this was the only significant relationship identified in the screening analyses. It may be that attitudes towards DS do not always play a significant role in screening decisions because they are not always seen as relevant at this stage in the testing process (Bryant et al, 2010). The relationship between ambivalence to DS and amniocentesis intention was stronger although it is likely that concern about miscarriage is also an important factor in uncertainty in this respect (Sapp et al, 2010).…”

“…In a sample of pregnant women, Bryant, Green, and Hewison (2010) found that attitudes towards people with DS were significantly associated with screening uptake and with diagnostic testing and termination intentions. Those who used screening and (hypothetically) intended to use amniocentesis and termination held less-positive attitudes towards the condition than did those who did not use/did not intend to use them.…”

“…We anticipated that those women who expressed uncertainty about their testing and termination intentions would hold more ambivalent attitudes towards DS than those women who expressed certainty about their intentions. The data presented were collected as part of a larger study (Bryant et al, 2010); the presented analyses focus on the relationships between attitudinal ambivalence towards DS and prenatal testing and termination intentions.…”

Arrays in postnatal and prenatal diagnosis: An exploration of the ethics of consent

“…One problem with this approach is that any list of categories may not sufficiently account for the variable expression of many disorders. A further concern is that the severity of different diseases is perceived differently between and among professionals [Wertz and Knoppers, 2002] and pregnant women [Bryant et al, 2010]. As indicated, the practical feasibility of such alternative models of informed consent needs to be tested in empirical studies.…”