Interactive tools may help patients make informed decisions about prenatal tests

A computerized decision-support guide may help women make more informed choices about prenatal testing, according to results of a randomized trial published in JAMA. The findings, which require validation in other populations, suggest that, were women better educated about the technology, fewer prenatal tests would be done.

Performed from 2010 to 2013 and largely before cell-free DNA testing became available, the trial was conducted in 3 county hospitals, 1 community clinic, 1 academic center, and 3 medical centers in the San Francisco Bay area. The 710 participants were English- and Spanish-speaking women who had not yet undergone screening or diagnostic testing and remained pregnant at 11 weeks’ gestation.

The women were randomized to a computerized, interactive decision-support guide and access to prenatal testing with no out-of-pocket expenses (n=357) or to usual care as per current guidelines (n=353).  The decision-support guide was used by the women at an interview site, in English or Spanish depending on a participant’s preference, and consisted of a 45- to 60-minute audio, video, and text program narrated by a bilingual actress emulating a friend. A 20-minute telephone interview was done at 24 to 36 weeks’ gestation to measure patient-reported outcomes and medical records were reviewed postpartum to determine what prenatal testing the women had undergone.

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Women randomized to the intervention group were less likely to have invasive diagnostic testing (5.9% vs 12.3%; odds ratio [OR], 0.45 [95% CI, 0.25-0.80]) and more likely to forgo testing altogether (25.6% vs 20.4%; OR, 3.30 [95% CI, 1.43-7.64], reference group screening followed by invasive testing). Women randomized to the intervention group also had higher knowledge scores (9.4 vs 8.6 on a 15-point scale; mean group difference, 0.82 [95% CI, 0.34-1.31]) and were more likely to correctly estimate the amniocentesis-related miscarriage risk (73.8% vs 59.0%; OR, 1.95 [95% CI, 1.39-2.75]) and their estimated age-adjusted chance of carrying a fetus with trisomy 21 (58.7% vs 46.1%; OR, 1.66 [95% CI, 1.22-2.28]).

The researchers concluded that their findings “support…the contention that women may not be receiving adequate counseling about their options. This underscores the need for clinicians to be clear that prenatal testing is not appropriate for everyone, and to present forgoing testing as a reasonable choice.”

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