title: Framing the decision: determinants of how women considering multifetal pregnancy reduction as a pregnancy-management strategy frame their moral dilemma.
abstract: OBJECTIVE
  How people make decisions regarding medical technologies and procedures are affected by how they 'frame' those decisions. Medical frames are characterized by a reliance on statistics regarding outcomes and risk to mother and surviving embryos, emphasize the influence of medical authorities, and are driven by a desire to minimize medical risks. Moral frames, on the other hand, are driven more by a desire to minimize the disruption to antiabortion and antireduction moral precepts, and weight heavily the advice of religious leaders. These frames contest with one another. Our objective is to examine the biographical determinants of frame dominance in this contest as it applies to multigestation pregnancies where selective reduction is being considered as a pregnancy-management strategy.
  
  
  METHODS
  For a sample of 55 multigestation women considering multifetal reduction as a pregnancy-management strategy, we develop a distinction between medical and moral frames. Semistructured interviews generated qualitative data that were independently coded by two researchers. These variables were then analyzed using dummy variable regression analysis.
  
  
  RESULTS
  Conceptualizing these frames as anchoring opposite ends of a continuum, we show that 40% of the variance in frame dominance can be accounted for by three factors: how involved patients are in religious institutions that have antiabortion norms, whether they have medico-scientific careers, and how pro-reduction their advice has been from fertility specialists and obstetricians prior to coming to the clinic.
  
  
  CONCLUSIONS
  The implication of these results for practice include recognizing the wide variation in patient's perceptions of their situations and how these perceptual frames alter how women confront risk-benefit statistics and being flexible in one's approach to counseling patients. This approach can further serve as a model for similar reproductive-health dilemmas.
authors.affiliation: Institute for Genetics and Fetal Medicine, St. Luke's-Roosevelt Hospital, Columbia University, New York, NY 10019, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Britt
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Evans
authors.forename: Shilpi S
authors.initials: SS
authors.lastname: Mehta
authors.forename: Mark I
authors.initials: MI
authors.lastname: Evans
mesh_terms: D002321:Career Choice; D003657:Decision Making; D005260:Female; D006801:Humans; D008511:Medicine; D009014:Morals; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000523:psychology*; D011272:Pregnancy, Multiple / Q000523:psychology*; D012067:Religion; D012586:Science