title: Evaluation of preferences of women and healthcare professionals in Singapore for implementation of noninvasive prenatal testing for Down syndrome.
abstract: BACKGROUND
  Invasive prenatal diagnosis (IPD) has long been used to prenatally diagnose Down syndrome (DS), but it is associated with a small risk of miscarriage. Noninvasive prenatal testing (NIPT) is a highly sensitive screening test using cell-free DNA in maternal blood for detection of DS without the risk of miscarriage, but it confers a small risk of false-positive and false-negative results. The implementation of these procedures into clinical practice requires an understanding of stakeholder preferences.
  
  
  METHODS
  A total of 69 health professionals (HPs) and 301 women took part in a discrete choice experiment (DCE) in which preferences for four prenatal test attributes - accuracy, time of results, risk of miscarriage and amount of information provided - were assessed. Conditional logit regression was used to analyse the data. Data on demographics and ranked preferences for test attributes was collected, and a direct choice question regarding NIPT, IPD or neither test was posed to participants.
  
  
  RESULTS
  The women showed a preference for test safety, whereas HPs prioritised test accuracy above all other attributes. When offered a direct choice of NIPT, IPD or neither test, women aged 35 years and older, those with previous miscarriage or who knew a child with DS were more likely to choose NIPT. Chinese women preferred NIPT, whereas Indian women preferred IPD.
  
  
  CONCLUSIONS
  Our data highlights the need for patient-specific counselling, taking into account previous experiences and cultural factors. Since women and HPs prioritise different test attributes, it is essential that HPs recognise these differences in order to provide non-biased counselling.
authors.affiliation: Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.
authors.forename: Angela Natalie
authors.initials: AN
authors.lastname: Barrett
authors.affiliation: Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.
authors.forename: Henna Vishal
authors.initials: HV
authors.lastname: Advani
authors.affiliation: Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, United Kingdom.
authors.forename: Lyn S
authors.initials: LS
authors.lastname: Chitty
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Lin Lin
authors.initials: LL
authors.lastname: Su
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Arijit
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Wei Ching
authors.initials: WC
authors.lastname: Tan
authors.affiliation: Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, United Kingdom.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hill
authors.affiliation: Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.|Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Choolani
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D062145:Maternal Serum Screening Tests; D057240:Patient Preference / Q000706:statistics & numerical data; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D015203:Reproducibility of Results; D012846:Singapore
keywords: NIPT; cell-free DNA; cell-free fetal DNA; prenatal screening