Risk communication, prenatal screening, and prenatal diagnosis: the illusion of informed decision-making

Pregnant women's knowledge of prenatal tests was assessed in face-to-face interviews. The focus of the study was on how physicians communicate test results to their clients and whether women possess enough information to make informed decisions. Thirty-five women located in the German-speaking part of Switzerland participated in the study, which was based on half-standardized interviews lasting about an hour. Standardized questions were used to measure women's knowledge of prenatal tests. In selecting women to participate in the study, we ensured that they were counseled by different physicians. Results showed that most participants overestimated the risk of having a baby with Down syndrome. Most women had difficulties in interpreting a positive test result associated with blood tests (i.e., PAPP-A), but almost all women knew that this test provides a probabilistic outcome. Most women had very accurate knowledge of the risk of a miscarriage associated with invasive tests (i.e., amniocentesis, chorionic villus sampling). A substantial percentage of the women, however, did not realize that the invasive tests are also probabilistic tests. Overall, results of our study suggest that approaches to risk communication vary across physicians. There seems to be no standardization in counseling. In addition, our results suggest that many pregnant women may lack the knowledge necessary to make informed decisions regarding prenatal tests.