Use of a decision aid for prenatal testing of fetal abnormalities to improve women's informed decision making:a cluster randomized controlled trial

Objective: To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a pamphlet in supporting women's decision making. Design: A cluster randomised controlled trial. Setting: Primary health care. Population: Women in early pregnancy consulting a GP. Methods: GPs were randomised to provide women with either a decision aid or a pamphlet. The decision aid was a 24-page booklet designed using the Ottowa Decision Framework. The pamphlet was an existing resource available in the trial setting. Main outcome measures: Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post. Findings: Women in the intervention group were more likely to make an informed decision 76 (126/165) than those in the control group 65 (107/165) (adjusted OR 2.08; 95 CI 1.14 to 3.81). A greater proportion of women in the intervention group 88 (147/167) had a "good" level of knowledge than those in the control group 72 (123/171) (adjusted OR 3.43; 95 CI 1.79 to 6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), pamphlet 1.65 (0.55) (adjusted mean difference 0.10; 95 CI 0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes. Conclusion: A tailored prenatal testing decision aid plays an important role in improving women's knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values