370: Zika Virus screening and testing: preferences for prenatal diagnosis and tolerance of uncertainty

Zika virus (ZIKV) is a teratogenic flavivirus recently linked to a congenital syndrome characterized by severe microcephaly, fetal CNS lesions and growth restriction. CDC recommendations for ZIKV are rapidly evolving. Current recommendations include serum testing with serial ultrasound and consideration of amniocentesis. A high level of global uncertainty exists regarding ZIKV. We explored patient desires for ZIKV screening and testing in relation to their tolerance of uncertainty. We administered a single electronic survey in our institution between 6/21/2016 and 7/19/2016. The survey included demographic information, a validated Intolerance of Uncertainty scale (IUS-12), and 4 clinical scenarios. In all scenarios, the patient traveled to an area of ZIKV transmission and had a combination of serum and ultrasound findings at 18 weeks gestation representing increasing levels of clinical risk. Participants were separated based on IUS-12 score and the upper (high tolerance) and lower (low tolerance) quartiles were compared regarding preferences for further screening and testing across scenarios using chi-square test. A total of 463 obstetric patients completed the survey. The majority of participants were between the ages of 26-35 (67%), Caucasian (71%) and born in the US (87%). The median IUS-12 score was 26 (IQR 21-32). There were few differences in patient screening/testing preferences based on tolerance of uncertainty. Women with low tolerance of uncertainty desire further ultrasound screening in the low-risk scenario (p=0.03) and consider pregnancy termination in the high-risk scenario (p=0.02). (Table) If exposed to ZIKV, the majority of women desire further investigation regardless of their tolerance of uncertainty. Women with the lowest tolerance of risk were more likely to desire further ultrasounds in the low risk scenario as well as more likely to consider termination in the high risk scenario. These results support strong consideration of patient preferences in ZIKV screening and diagnosis strategies.