Computerized Prenatal Genetic Testing Decision-Assisting Tool

TLDR

Guidelines recommend that all pregnant women receive fetal aneuploidy screening and diagnostic testing and that providers explain test differences to facilitate informed decisions. The study aimed to evaluate the impact of a computerized, interactive prenatal testing decision tool on women’s decision‑making. Six hundred women ≤20 weeks gestation were randomized to view the interactive tool or a standard educational booklet, with primary outcomes of knowledge, risk awareness, satisfaction, decisional conflict, and, for those ≥35 years, use of invasive diagnostic testing. Women who used the interactive tool achieved higher knowledge scores, more accurate risk estimates, greater satisfaction, and lower decisional conflict, with these benefits persisting over time and influencing invasive testing decisions among older women. Clinical trial NCT00686062 (Level I evidence) confirms that the interactive decision tool improves prenatal genetic testing decisions compared with standard booklets.

Abstract

In Brief OBJECTIVE: Guidelines for fetal aneuploidy testing recommend that screening and diagnostic testing be made available to pregnant women of all ages and that providers explain the differences between these tests to help their patients make informed testing decisions. We sought to estimate the effect of a computerized, interactive prenatal testing decision tool on prenatal testing decision making. METHODS: Four hundred ninety-six English- or Spanish-speaking women at 20 or fewer weeks of gestation were randomly assigned to view the interactive prenatal testing decision tool or the California Department of Health Services' educational booklet. Primary outcomes were knowledge, risk awareness, intervention satisfaction, decisional conflict, and among women aged at least 35 years, use of invasive diagnostic testing. RESULTS: Women assigned to the interactive prenatal testing decision tool had higher knowledge scores (79.5% compared with 64.9%, P<.001), were more likely to correctly estimate their risk of procedure-related miscarriage (64.9% compared with 48.1%, P=.002) and carrying a Down syndrome-affected fetus (63.5% compared with 15.1%, P<.001), were more satisfied with the intervention (P<.001), and had less decision uncertainty (P<.001) than controls after viewing the intervention. Most of these differences persisted over time. Among women aged at least 35 years, the interactive prenatal testing decision tool viewers who were originally less inclined to undergo invasive testing were ultimately more likely than similarly inclined controls to have amniocentesis or chorionic villus sampling (44.8% compared with 29.2%), whereas those who were originally more inclined to undergo an invasive procedure ultimately were less likely than similarly inclined controls to have a diagnostic procedure (84.6% compared with 94.9%; P=.015 for interaction). CONCLUSION: Using an interactive prenatal testing decision tool results in more informed prenatal genetic testing decisions than viewing standard educational booklets. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00686062 LEVEL OF EVIDENCE: I Compared with use of standard educational booklets, an interactive, computerized, decision-assisting tool helps pregnant women make more informed prenatal testing decisions.