American Journal of Obstetrics and Gynecology
ResearchGeneticsDoes labeling prenatal screening test results as negative or positive affect a woman’s responses?
Section snippets
Overview of study design
Each participant was asked to imagine being 4 months pregnant and speaking with her physician regarding prenatal screening tests for fetal chromosomal problems. We randomly varied both initial risk status and the format of the hypothetical test results and then assessed the participants’ risk perceptions and behavioral intentions. This design received institutional review board exempt status approval as anonymous survey research.
Participants
Study participants were women 18-50 years old who were drawn from
Results
A total of 1785 women reached the survey website and viewed the first content page. Of these, 10 women were excluded for reporting ages outside of the requested sample range, and 87 women did not complete the relevant sections of the survey. Our analyses focus on the remaining 1688 participants (94.5%).
Sample mean age was 35 years (range, 18-50 years). Of the 1627 women who reported racial and/or ethnic background information, 84% of the women described themselves as white; 14% of the women
Comment
In purely rational terms, decisions regarding invasive tests such as amniocentesis should be based on the estimated risk of fetal problems that is generated from the screening test and each couple’s personal preferences. Although research suggests that women can incorporate such risk information effectively into their decision-making,11 decisions regarding amniocentesis are influenced by the a priori risk level12 and do not always appear to correlate clinically with the test results that are
Acknowledgments
We thank Jonathan Kulpa for his research assistance and Miriam Kuppermann and 2 anonymous reviewers for helpful comments on an earlier version of this manuscript.
References (24)
- et al.
Informed choice in antenatal Down syndrome screening: a cluster-randomized trial of combined versus separate visit testing
Patient Educ Couns
(2006) - et al.
Informed decision making in the context of prenatal screening
Patient Educ Couns
(2006) - et al.
Presenting a routine screening test in antenatal care: practice observed
Public Health
(1992) - et al.
Patients’ understanding of medical risks: implications for genetic counseling
Obstet Gynecol
(1999) - et al.
Evidence-based obstetric ethics and informed decision-making by pregnant women about invasive diagnosis after first-trimester assessment of risk for trisomy 21
Am J Obstet Gynecol
(2005) - et al.
Variation in uptake of serum screening: the role of service delivery
Prenat Diagn
(2002) - et al.
Informed consent to serum screening for Down syndrome: are women given adequate information?
Prenat Diagn
(1999) - et al.
Beyond race or ethnicity and socioeconomic status: Predictors of prenatal testing for Down syndrome
Obstet Gynecol
(2006) - et al.
Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women’s attitudes or a failure to facilitate informed choices?
Int J Epidemiol
(2005) - et al.
General performance on a numeracy scale among highly educated samples
Med Decis Making
(2001)
Judgment under uncertainty: heuristics and biases
Science
The influence of serum screening on the amniocentesis rate in women of advanced maternal age
Prenat Diagn
Cited by (31)
The influence of risk labeling on risk perception and willingness to seek help in an experimental simulation of preventive medical examinations
2018, Patient Education and CounselingCitation Excerpt :Men tended to report higher risk perception and willingness to seek help than women, but their scores generally did not differ statistically from those reported by women. Our findings are consistent with a study on prenatal screening which demonstrated that the labeling of test results influences risk perception and behavior intention [9]. By labeling test results in terms of risk, rather than simply stating the findings, workers tend to be more concerned about the results and are more inclined to seek intervention.
Use of psychology and behavioral economics to promote healthy eating
2014, American Journal of Preventive MedicineCitation Excerpt :Peters and colleagues20,21 offer several reasons why numbers present a processing challenge: they are abstract, the meaning of the same number changes in different contexts, and differences in numbers typically reflect small and unfamiliar discrepancies. Other research22 has found that depicting statistical information in pictographs reduced medical patients’ reliance on anecdotes when making decisions, and another study23 found that evaluative labels (e.g, “normal,” “positive”) presented with prenatal screening test results were better able to influence risk perceptions and behavioral intentions than were numbers. Such research can inform current debates about the type of nutrition labels that should be displayed on the front of packaged foods.
The development and testing of a brief ('gist-based') supplementary colorectal cancer screening information leaflet
2013, Patient Education and CounselingCitation Excerpt :To overcome these difficulties, we attempted to encourage gist-based processing by providing a verbal description of the number which provides an evaluative label (i.e. gist) of the number (e.g. ‘most people [98 out of 100]’). This approach has been used successfully in previous research [28–30], with evidence to suggest it increases deliberative processing of the numerical information [31]. In line with current evidence, natural frequencies with the same denominator were used to present key numerical information [32].
Management of pregnancies with a previous cesarean
2012, Journal de Gynecologie Obstetrique et Biologie de la ReproductionRisky feelings: Why a 6% risk of cancer does not always feel like 6%
2010, Patient Education and CounselingCitation Excerpt :Providing comparative risk statistics, however, is by no means the only way to change the intuitive meanings patients draw from risk statistics. For example, a study that examined prenatal genetic screening decisions showed that the seemingly innocuous practice of labeling a screening test result as “negative” or “positive” significantly changed both people's risk perceptions and their decision making about amniocentesis as compared to simply providing the statistical risk information without additional interpretation [53]. The concept that evaluative labels can be particularly influential is also supported by recent work by Peters et al. that demonstrated that a manipulation of “evaluative mapping” that provided both verbal and visual categorizations of statistics into categories such as “fair” or “good” resulted in increased use of numerical information in a quality-of-care decision by a less numerate population [54].
Understanding Risk, Patient and Provider Preferences, and Obstetrical Decision Making: Approach to Delivery After Cesarean
2010, Seminars in PerinatologyCitation Excerpt :Research in genetic counseling shows that the self-perception of risk before a discussion has a significant “anchoring effect,” pulling the risk estimate in the direction of the patients' preformed opinion.14 It also has been demonstrated that labeling a result as positive or negative, or reporting the likelihood of having a healthy child rather than the likelihood of having an affected child, has an effect not only on the patient's risk estimate, but on her likelihood of choosing to proceed with an invasive diagnostic procedure.15,16 Finally, reasoning about risk in pregnancy is sometimes compromised by the tendency to consider probabilities out of the context of patient values and to consider elimination of any fetal risk as paramount.3
Supported in part by the National Institutes for Health (R01 CA87595 and P50 CA101451), by a career development award from the American Cancer Society (MRSG-06-130-01-CPPB [B.J.Z-F.]), and by a Merit Review Entry Program early career award from the Department of Veterans Affairs (A.F.).
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
Cite this article as: Zikmund-Fisher BJ, Fagerlin A, Keeton K, Ubel PA. Does labeling prenatal screening test results as negative or positive affect women’s responses? Am J Obstet Gynecol 2007;197:528.e1-528.e6.