How do distress levels affect women's decision-making for invasive prenatal genetic testing?

Decision-making is a complex process with many influential factors, including a person’s emotional state. The purpose of this study was to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering invasive prenatal genetic diagnostic testing (PGDT), and to assess the relationship between these constructs. Cross-sectional design employing a voluntary, anonymous questionnaire (Q) assessing patient decision-making process in regards to PGDT (CVS or amniocentesis). Paper and online Qs were distributed from 2017-2019 to women referred for PGDT in a university academic practice. Exclusion criteria: English or Spanish illiterate. Baseline maternal characteristics were collected. Questions, adapted from validated Qs, evaluated distress, decisional certainty and decisional clarity on a 5-point Likert scale (range: 0=low/uncertain/unclear to 4=high/certain/clear, respectively). Means, variances (SD), and ranges were tabulated. Correlation statistics were run between scores with alpha < 0.05. 44 female patients completed the Q. The majority were married (68%), white (77%), Catholic (45%), and multiparous (75%). 57% of patients had already made a testing decision at the time of the Q. Overall, patients expressed low distress levels (mean 1.18, SD 0.80) and expressed high decisional certainty (mean 3.28, SD 0.76) and clarity (mean 3.30, SD 0.99) towards PGDT. Decisional certainty and clarity were positively correlated (r=0.47, p< 0.01), whereas distress was negatively correlated with decisional certainty (r= -0.8136, p< 0.0005) and decisional clarity (r= -0.49, p=0.007). See Figures 1 and 2. Higher maternal distress summary scores were associated with lower decisional certainty and decisional clarity. Women considering PGDT could benefit from decisional support, including strategies to reduce emotional distress, to improve their decision-making experience.View Large Image Figure ViewerDownload Hi-res image Download (PPT)