MedicalResearch.com Interview with:
Valerie Seror, PhD
French Institute of Health and Medical Research
MedicalResearch.com: What is the background for this study?
Response: In the highly sensitive context of prenatal diagnosis where autonomous and informed decision-making is of crucial issue, the present study is a companion study to a prospective clinical trial [ClinicalTrials.gov Identifier: NCT02127515] aiming at comparing clinical benefits involved by invasive vs. non-invasive testing in women at high risk of Down syndrome following routine combined screening.
Our study (involving 2,436 consecutive high-risk pregnant women following combined screening for Down syndrome) confirmed that attitudes towards invasive testing are notably guided by risk aversion to invasive testing-related fetal loss whereas it showed that attitudes towards non-invasive testing are notably guided by aversion to the ambiguity generated by results restricted to the only targeted abnormalities.
MedicalResearch.com: What are the main findings?
Response: Those pregnant women with higher nuchal translucency measurements (i.e. at higher risk at this stage of screening) were more likely to report aversion to ambiguity conveyed by non-invasive testing results, suggesting the possibility of a common perception bias (the base rate fallacy bias): being informed about ultrasound screening results for some time could prompt pregnant women to extrapolate on their overall risk.
As a result, ultrasound screening was found to shape high-risk women’s attitudes, just as age has been shown to shape attitudes towards invasive testing among low risk pregnant women. Otherwise, the role played by education and religious beliefs on attitudes was confirmed.
Overall, pregnant women’s decisions were consistent with their attitudes, keeping in mind that attitudes and behaviors were studied within the framework of a clinical trial.
MedicalResearch.com: What should readers take away from your report?
Response: Offering the choice between invasive and non-invasive testing allows high-risk pregnant women to express their own trade-off between pregnancy risk taking and extent of information seeking. Informed decision-making would require extensive information on abnormalities targeted by both non-invasive and invasive testing. While pregnant women had been shown to greatly differ in terms of extent of information seeking, tolerance for uncertainty and pregnancy risk taking, counseling should also involve listening to women’s preferences as to what they want to get out of prenatal testing.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Introducing non-invasive testing in prenatal diagnosis strengthened the major issue of the information to be provided to favor informed decision-making. Further research should be conducted on this key-element for decision-making.
Seror V, L’Haridon O, Bussières L, et al. Women’s Attitudes Toward Invasive and Noninvasive Testing When Facing a High Risk of Fetal Down Syndrome. JAMA Netw Open. 2019;2(3):e191062. doi:10.1001/jamanetworkopen.2019.1062
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