Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say?
Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors influencing pregnant women's use of a patient decision aid for deciding about prenatal screening for Down syndrome (DS).



This qualitative study was embedded in a sequential mixed-methods research program whose main aim is to implement shared decision-making (SDM) in the context of prenatal screening for DS in the province of Quebec, Canada. We planned to recruit a purposive sample of 45 pregnant women with low-risk pregnancy consulting for prenatal care at three clinical sites. Participating women watched a video depicting a prenatal care follow-up during which a pregnant woman, her partner and a health professional used a PtDA to decide about prenatal screening for DS. The women were then interviewed about factors that would influence the use of this PtDA using questions based on the Theoretical Domains Framework (TDF). We performed content analysis of transcribed verbatim interviews.



Out of 216 eligible women, 100 agreed to participate (46% response rate) and 46 were interviewed. Regarding the type of health professional responsible for their prenatal care, 19 participants (41%) reported having made a decision about prenatal screening for DS with an obstetrician-gynecologist, 13 (28%) with a midwife, 12 (26%) with a family physician, and two (4%) decided on their own. We identified 54 factors that were mapped onto nine of the 12 TDF domains. The three most frequently-mentioned were: opinion of the pregnant woman's partner (n = 33, 72%), presentation of the PtDA by health professional and a discussion (n = 27, 72%), and not having encountered a PtDA (n = 26, 57%).



This study allowed us to identify factors influencing pregnant women's use of a PtDA for prenatal screening for DS. Use of a PtDA by health professionals and patients is one step in providing the needed decision support and our study results will allow us to design an effective implementation strategy for PtDAs for prenatal screening for DS.
Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada.
Maria Esther Leiva
ME
Portocarrero
Centre d'Excellence sur le Vieillissement de Québec, CHU de Québec Research Centre, Quebec, Canada.|Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada.
Anik M C
AM
Giguère
Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada.
Johanie
J
Lépine
Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada.
Mirjam M
MM
Garvelink
Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada.
Hubert
H
Robitaille
Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada.
Agathe
A
Delanoë
CHU de Québec, Hôpital St-François d'Assise, and Obstetrics and Gynecology Department, Faculty of Medicine, Laval University, Quebec, Canada.
Isabelle
I
Lévesque
Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
Brenda J
BJ
Wilson
Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Laval University, Quebec, Canada.|Health Technology Assessment and Evidence-based Laboratory Medicine, Quebec, Canada.
François
F
Rousseau
Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada. France.Legare@mfa.ulaval.ca.|Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada. France.Legare@mfa.ulaval.ca.|Population Health and Optimal Health Practice Research Group, CHU de Québec Research Centre, Hôpital St-François d'Assise, 10, rue de l'Espinay/D6-730, Quebec, G1L 3L5, Canada. France.Legare@mfa.ulaval.ca.
France
F
Légaré
D000328:Adult; D003657:Decision Making; D003661:Decision Support Techniques; D004314:Down Syndrome / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011296:Prenatal Diagnosis / Q000523:psychology*; D036301:Qualitative Research; D011792:Quebec
Decision aid; Down syndrome; Implementation; Knowledge translation; Prenatal testing; Shared decision making; Theoretical domains framework; Trisomy 21