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Updated: Jun 18, 2025
FISH for Pre-implantation Genetic Diagnosis
Published on: February 23, 2011
Identifying Strategies to Improve Shared Decision Making for Pregnant Patients' Decisions about Prenatal Genetic
Christina Collart1, Caitlin Craighead1, Meng Yao2
1Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA.
Insights
A shared decision-making (SDM) tool did not significantly improve discussions about prenatal genetic testing. Further efforts are needed to enhance patient understanding and informed choices regarding these crucial tests.
Area of Science:
- Obstetrics and Gynecology
- Genetics
- Health Services Research
Background:
- Prenatal genetic screening and diagnostic tests are essential components of prenatal care.
- The first prenatal visit is a critical juncture for patients to decide on these tests and other care aspects.
- Shared decision-making (SDM) is crucial for navigating these complex choices.
Purpose of the Study:
- To evaluate the effectiveness of a shared decision-making (SDM) instrument in supporting discussions about prenatal genetic testing.
- To examine the role of SDM in enhancing informed decision-making during the first prenatal visit.
Main Methods:
- A cluster randomized controlled trial was conducted, allocating patients to either an SDM tool or usual care.
- Participants completed baseline surveys on decision-making needs and preferences.
- Direct observation using the OPTION scale assessed the level of SDM during prenatal genetic testing discussions.
Main Results:
- No significant difference in the levels of SDM was observed between the SDM tool group and the usual care group (P=0.081).
- Highest SDM levels were noted during screening test discussions, while lowest levels occurred when discussing risk versus diagnostic information preferences.
Conclusions:
- Targeted patient- and provider-focused interventions are necessary to improve SDM in prenatal genetic testing discussions.
- Patients' baseline knowledge and attitudes must be considered, with tailored communication for those with less prior understanding.
- Enhancing informed decision-making for prenatal genetic tests requires focused efforts early in pregnancy.
Purpose:
Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions.
Methods:
We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions.
Results:
Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3).
Conclusion:
Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients' informed decision making about these options. Importantly, patients' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication.
Highlights:
Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients' ability to make informed decisions about prenatal genetic tests in early pregnancy.
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