Optimizing Prenatal Testing Decision-Making

This project will study the role of patient preferences and other factors in choices regarding use of prenatal screening for and diagnosis of chromosomal disorders in a racially/ethnically diverse population. The study will collect detailed information regarding the distribution of individual preferences for test characteristics and outcomes by racial/ethnic group, as well as other factors which may be related to choices regarding the use of these tests. The study will use both decision-analytic and regression techniques to compare 'predicted' choices (based on expected utility theory) to actual choices made. The study will also explore the cost-effectiveness of current and proposed age-and risk-based guidelines for prenatal testing, and will compare them to the estimated cost effectiveness of a preference-based guideline. Information generated in this study will ultimately be used in the development of a decision-assisting technology to help women of diverse backgrounds make informed choices regarding testing that reflect their underlying preferences, and in the delineation of guidelines for use of prenatal diagnostic services that place greater emphasis on patient preferences and values, in addition to risk.