Determinants of parental decisions after the prenatal diagnosis of down syndrome: bringing in context.

This article develops the concept of decision context to refer to the combinations of factors that are important in understanding and predicting termination decisions after a prenatal diagnosis of trisomy 21. Four factors are examined: maternal age, gestational age, prior voluntary abortion, and existing children. The cases were studied at the Wayne State University's Reproductive Genetics Clinic. Qualitative comparative analysis, a technique specifically designed for examining the impact of combinations of factors, is used to isolate influential decision contexts. Odds and odds ratios are used to pinpoint outcome differences among different decision contexts. Four alternative decision contexts are especially conducive to choosing to terminate a pregnancy. Two of these involve women of any age and are formed from combinations of gestational age and existing children (existing children and low gestational age, and no children combined with late gestational age). Older women who have not had an abortion and who discover the trisomy 21 anomaly early are likely to choose termination. Younger women who have had an abortion are also likely to choose termination. Our data suggest there are added layers of complexity to patients' decisions that derive from combinations of conditions. An additional, strong implication is that qualitative comparative analysis may be particularly useful in understanding such complexity. Copyright 2000 Wiley-Liss, Inc.