Use of a decision aid for prenatal testing of fetal abnormalities to improve women’s informed decision making: a cluster randomised controlled trial [ISRCTN22532458]
Corresponding Author
C Nagle
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Dr C Nagle, Maternity Services Education Program, Royal Women’s Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia. Email [email protected]Search for more papers by this authorJ Gunn
Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
Search for more papers by this authorR Bell
Women’s Health Program, Department of Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Prahran, Victoria, Australia
Search for more papers by this authorS Lewis
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorB Meiser
Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
Search for more papers by this authorS Metcalfe
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorOC Ukoumunne
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorJ Halliday
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorCorresponding Author
C Nagle
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Dr C Nagle, Maternity Services Education Program, Royal Women’s Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia. Email [email protected]Search for more papers by this authorJ Gunn
Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
Search for more papers by this authorR Bell
Women’s Health Program, Department of Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Prahran, Victoria, Australia
Search for more papers by this authorS Lewis
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorB Meiser
Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
Search for more papers by this authorS Metcalfe
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorOC Ukoumunne
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorJ Halliday
Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Search for more papers by this authorAbstract
Objective To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a pamphlet in supporting women’s decision making.
Design A cluster randomised controlled trial.
Setting Primary health care.
Population Women in early pregnancy consulting a GP.
Methods GPs were randomised to provide women with either a decision aid or a pamphlet. The decision aid was a 24-page booklet designed using the Ottowa Decision Framework. The pamphlet was an existing resource available in the trial setting.
Main outcome measures Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post.
Findings Women in the intervention group were more likely to make an informed decision 76% (126/165) than those in the control group 65% (107/165) (adjusted OR 2.08; 95% CI 1.14–3.81). A greater proportion of women in the intervention group 88% (147/167) had a ‘good’ level of knowledge than those in the control group 72% (123/171) (adjusted OR 3.43; 95% CI 1.79–6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), pamphlet 1.65 (0.55) (adjusted mean difference 0.10; 95% CI −0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes.
Conclusion A tailored prenatal testing decision aid plays an important role in improving women’s knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values.
Supporting Information
The following supplementary materials are available for this article:
Appendix S1. Multidimensional Measure of Informed Choice.
Appendix S2. Decisional Conflict Scale.
These materials are available as part of the online article from: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.2007.01576.x.
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Please note: Blackwell Publishing is not responsible for the content or functionality of any supplementary materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.
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