Full Disclosure

166132487If you’re a woman, pretend for a moment that you’re pregnant.  If you’re a man, imagine you’re a woman who’s pregnant.  Then address the question, would you chose to undergo prenatal testing?  If the answer is yes, which type of testing would you chose?  Finally, what would you do based on the results? As Rick and I discuss on PodMed this week, a JAMA study elegantly demonstrates that pregnant women can be educated and informed regarding prenatal testing using a computer-based tool, and that when they are so-informed, even when prenatal testing of all types is offered free of charge, they chose to undergo such testing only half of the time a control group choses it.  Our conclusion is that development and utilization of such educational tools is practical and should likely be expanded to a host of complex healthcare decisions, particularly as people are being called upon more and more to engage in ‘shared decision making’ with their healthcare providers.  Let’s take a look at the study.

Researchers recruited from prenatal clinics in a variety of healthcare settings in the San Francisco area, representative of many economic and educational strata as well as ethnicity. All women were less than or equal to 20 weeks of gestation with no history of previous prenatal testing in the current pregnancy. A total of 710 women were recruited, 357 of whom were randomized to a computerized interactive decision support guide conducted in their choice of either English or Spanish, along with remission of fees for any prenatal testing they chose that was not covered by their insurance, or the remainder to routine care.

The computerized guide was administered at an interview site and took 45 to 60 minutes to complete.  The guide utilizes video, text, audio and graphics and a bilingual female narrator to describe prenatal testing options and their potential risks and benefits. The program emphasizes that the range of choices available are all reasonable and personal and optional additional detail is provided.  Outcomes for the study included whether and which prenatal testing options were chosen by the women, verified by medical records, and an assessment by telephone of subject regret later in pregnancy on which choices were made. As I’ve
already foreshadowed, invasive prenatal testing was selected about half of the time among those who were administered the computer guide as those who received usual care.  Moreover, those women who saw the guide were very happy with their decision later in pregnancy, as was the control group.

What this study tells Rick and me is it's very practical to offer this kind of guide to people making complex medical decisions, especially since it requires no additional time of any provider. So many decisions remind me of this!  Should you have arthroscopic knee surgery? cardiac stenting? carotid endarterctomy? the list seems endless.  If such an educational strategy were undertaken I believe it would empower people much more to feel responsible for their own health, and that's all to the good. Here, here!

Other topics this week include new Ebola estimates in MMWR, varicose vein treatment in NEJM, and PET scanning for lung cancer diagnosis in JAMA.  Until next week, y'all live well.

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