Miriam Kuppermann|Sherri Pena|Judith Bishop|Sanae Nakagawa|Steven E. Gregorich|Anita Sit|Juan Vargas|Aaron B. Caughey|Susan Sykes|Lasha Pierce|Mary E. Norton
Effect of Enhanced Information, Values Clarification, and Removal of Financial Barriers on Use of Prenatal Genetic Testing
University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|Santa Clara Valley Medical Center|University of California, San Francisco|Oregon Health & Science University|La Clinica de La Raza|University of California, San Francisco
h3importanceh3 prenatal genetic testing guidelines recommend providing patients detailed information allow informed preferencebased screening diagnostic testing decisions effect implementing guidelines well understood h3objectiveh3 analyze effect decisionsupport guide elimination financial barriers testing use prenatal genetic testing decision making among pregnant women varying literacy numeracy levels h3design setting participantsh3 randomized trial conducted 20102013 prenatal clinics 3 county hospitals 1 community clinic 1 academic center 3 medical centers integrated health care delivery system san francisco bay area participants english spanishspeaking women yet undergone screening diagnostic testing remained pregnant 11 weeks gestation n 710 h3interventionsh3 computerized interactive decisionsupport guide access prenatal testing outofpocket expense n 357 usual care per current guidelines n 353 h3main outcomes measuresh3 primary outcome invasive diagnostic test use obtained via medical record review secondary outcomes included testing strategy undergone knowledge testing risk comprehension decisional conflict regret 24 36 weeks gestation h3resultsh3 women randomized intervention group compared randomized control group less likely invasive diagnostic testing 59 vs 123 odds ratio 045 95 ci 025080 likely forgo testing altogether 256 vs 204 330 95 ci 143764 reference group screening followed invasive testing women randomized intervention group also higher knowledge scores 94 vs 86 15point scale mean group difference 082 95 ci 034131 likely correctly estimate amniocentesisrelated miscarriage risk 738 vs 590 195 95 ci 139275 estimated ageadjusted chance carrying fetus trisomy 21 587 vs 461 166 95 ci 122228 significant differences emerge decisional conflict regret h3conclusions relevanceh3 full implementation prenatal testing guidelines using computerized interactive decisionsupport guide absence financial barriers testing resulted less test use informed choices validated additional populations approach may result informed preferencebased prenatal testing decision making fewer women undergoing testing h3trial registrationh3 clinicaltrialsgov identifiernct00505596