Abstract：
OBJECTIVE: Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions.
METHODS: We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions.
RESULTS: Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients\' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3).
CONCLUSIONS: Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients\' informed decision making about these options. Importantly, patients\' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication.
CONCLUSIONS: Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients\' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients\' ability to make informed decisions about prenatal genetic tests in early pregnancy.
METHODS: We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions.
RESULTS: Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients\' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3).
CONCLUSIONS: Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients\' informed decision making about these options. Importantly, patients\' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication.
CONCLUSIONS: Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients\' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients\' ability to make informed decisions about prenatal genetic tests in early pregnancy.
摘要：
目的：产前基因筛查和诊断测试是产前护理的重要组成部分。第一次产前检查是决策过程中的关键时刻，当患者决定是否使用这些测试以及解决一系列其他基本的产前护理方面时。我们进行了这项研究，以检查共享决策（SDM）工具的作用，以支持这些讨论。
方法：我们进行了一项整群随机对照试验，对象是患者在第一次产前检查时被分配到SDM工具或常规护理。参与者完成了一项基线调查，以衡量决策需求和偏好。在产前基因检测讨论期间，使用OPTION量表进行直接观察和分析以测量SDM。
结果：各组的SDM水平相似（P=0.081）。在筛选测试讨论期间观察到最高水平的SDM(NEST2.4±0.9对对照2.6±1.0)。在关于患者对风险偏好与诊断信息的讨论中观察到最低水平（NEST1.0±1.1与对照1.2±1.3）。
结论：研究结果表明，需要有针对性的以患者为中心和以提供者为中心的努力来改善SDM，以增强患者对这些选择的知情决策。重要的是,患者的基线知识和态度需要考虑，因为知识较少的患者可能需要更仔细的沟通。
结论：关于是否，when,如何使用产前基因检测是高度基于偏好的决定，患者对这些选择的基线态度是医疗保健讨论的主要驱动力。决策过程还取决于患者对医疗决策的共享或知情决策过程的偏好，这些决策过程是高度个人化的，并且对产科结果具有重大影响。有必要开展有针对性的努力，以改善决策并提高患者在妊娠早期做出有关产前基因检测的知情决策的能力。
方法：我们进行了一项整群随机对照试验，对象是患者在第一次产前检查时被分配到SDM工具或常规护理。参与者完成了一项基线调查，以衡量决策需求和偏好。在产前基因检测讨论期间，使用OPTION量表进行直接观察和分析以测量SDM。
结果：各组的SDM水平相似（P=0.081）。在筛选测试讨论期间观察到最高水平的SDM(NEST2.4±0.9对对照2.6±1.0)。在关于患者对风险偏好与诊断信息的讨论中观察到最低水平（NEST1.0±1.1与对照1.2±1.3）。
结论：研究结果表明，需要有针对性的以患者为中心和以提供者为中心的努力来改善SDM，以增强患者对这些选择的知情决策。重要的是,患者的基线知识和态度需要考虑，因为知识较少的患者可能需要更仔细的沟通。
结论：关于是否，when,如何使用产前基因检测是高度基于偏好的决定，患者对这些选择的基线态度是医疗保健讨论的主要驱动力。决策过程还取决于患者对医疗决策的共享或知情决策过程的偏好，这些决策过程是高度个人化的，并且对产科结果具有重大影响。有必要开展有针对性的努力，以改善决策并提高患者在妊娠早期做出有关产前基因检测的知情决策的能力。
