title: Considering medical risk information and communicating values: A mixed-method study of women's choice in prenatal testing.
abstract: BACKGROUND
  Nowadays, an important decision for pregnant women is whether to undergo prenatal testing for aneuploidies and which tests to uptake. We investigate the factors influencing women's choices between non-invasive prenatal testing (NIPT) and invasive prenatal tests in pregnancies with elevated a priori risk of fetal aneuploidies.
  
  
  METHODS
  This is a mixed-method study. We used medical data (1st Jan 2015-31st Dec 2015) about women participating in further testing at Fetomaternal Medical Center at Helsinki University Hospital and employed Chi-square tests and ANOVA to compare the groups of women choosing different methods. Multinomial logistic regressions revealed the significant clinical factors influencing women's choice. We explored the underlying values, beliefs, attitudes and other psychosocial factors that affect women's choice by interviewing women with the Theory of Planned Behavior framework. The semi-structured interview data were processed by thematic analysis.
  
  
  RESULTS
  Statistical data indicated that gestational age and counseling day were strong factors influencing women's choice. Interview data revealed that women's values and moral principles on pregnancy and childbirth chiefly determined the choices. Behavioral beliefs (e.g. safety and accuracy) and perceived choice control (e.g. easiness, rapidness and convenience) were also important and the major trade-offs happened between these constructs.
  
  
  CONCLUSIONS
  Values are the determinants of women's choice. Service availability and convenience are strong factors. Medical risk status in this choice context is not highly influential. Choice aids can be developed by helping women to identify their leading values in prenatal testing and by providing lists of value-matching test options and attributes.
authors.affiliation: Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland.
authors.forename: An
authors.identifier: http://orcid.org/0000-0001-9419-8254
authors.initials: A
authors.lastname: Chen
authors.affiliation: Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland.
authors.forename: Henni
authors.initials: H
authors.lastname: Tenhunen
authors.affiliation: Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland.
authors.forename: Paulus
authors.initials: P
authors.lastname: Torkki
authors.affiliation: Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen
authors.affiliation: Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland.
authors.forename: Paul
authors.initials: P
authors.lastname: Lillrank
authors.affiliation: Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Vedran
authors.initials: V
authors.lastname: Stefanovic
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000941:ethics / Q000523:psychology*; D000782:Aneuploidy; D002755:Choice Behavior / Q000941:ethics*; D005260:Female; D005820:Genetic Testing / Q000941:ethics*; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D057240:Patient Preference / Q000523:psychology; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011296:Prenatal Diagnosis / Q000941:ethics / Q000523:psychology*; D012307:Risk Factors