Fabiola Molina1, Christine Dehlendorf2, Steven E Gregorich3, Miriam Kuppermann4. 1. Department of Medicine, Brigham and Women's Hospital, Boston, USA. 2. Department of Family & Community Medicine, University of California, San Francisco, San Francisco, USA; Department of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA. 3. Department of Medicine, University of California, San Francisco, San Francisco, USA. 4. Department of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA. Electronic address: miriam.kuppermann@ucsf.edu.
Abstract
OBJECTIVE: To investigate women's preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience. METHODS: We conducted a secondary analysis of data from two randomized trials conducted between 2007-2012. Survey items assessed participants' preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes. RESULTS: 56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors. CONCLUSION: Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making. PRACTICE IMPLICATIONS: Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient's backgrounds and desires.
OBJECTIVE: To investigate women's preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience. METHODS: We conducted a secondary analysis of data from two randomized trials conducted between 2007-2012. Survey items assessed participants' preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes. RESULTS: 56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors. CONCLUSION: Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making. PRACTICE IMPLICATIONS: Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient's backgrounds and desires.
Authors: Nancy L Keating; Edward Guadagnoli; Mary Beth Landrum; Catherine Borbas; Jane C Weeks Journal: J Clin Oncol Date: 2002-03-15 Impact factor: 44.544