Research
Genetics
Does labeling prenatal screening test results as negative or positive affect a woman’s responses?

Presented at the 28th Annual Meeting of the Society for Medical Decision Making, Boston, MA, Oct. 15-18, 2006.
https://doi.org/10.1016/j.ajog.2007.03.076Get rights and content

Objective

We tested whether adding interpretive labels (eg, “negative test”) to prenatal genetic screening test results changes perceived risk and preferences for amniocentesis.

Study Design

Women (N = 1688) completed a hypothetical pregnancy scenario on the Internet. We randomly assigned participants into 2 groups: high risk of fetal chromosomal problems (12.5/1000) or low risk (2/1000). After prenatal screening, estimated risk was identical (5/1000) for all participants, but results were provided either alone or with interpretive labels.

Results

When receiving test results without labels, all participants react similarly. With labels, the participants who received “positive” or “abnormal” results reported a higher perceived risk (P < .001), greater worry (P < .001), and greater interest in amniocentesis (57% vs 37%; P < .001) than did the participants who received “negative” or “normal” results.

Conclusion

Interpretive labels for test results can induce larger changes to a woman’s risk perception and behavioral intention than can numeric results alone, which create decision momentum. This finding has broad clinical implications for patient–provider communication.

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.

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    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.

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