Does labeling prenatal screening test results as negative or positive affect a woman's responses?

OBJECTIVE We tested whether adding interpretive labels (eg, "negative test") to prenatal genetic screening test results changes perceived risk and preferences for amniocentesis. STUDY DESIGN Women (N = 1688) completed a hypothetical pregnancy scenario on the Internet. We randomly assigned participants into 2 groups: high risk of fetal chromosomal problems (12.5/1000) or low risk (2/1000). After prenatal screening, estimated risk was identical (5/1000) for all participants, but results were provided either alone or with interpretive labels. RESULTS When receiving test results without labels, all participants react similarly. With labels, the participants who received "positive" or "abnormal" results reported a higher perceived risk (P < .001), greater worry (P < .001), and greater interest in amniocentesis (57% vs 37%; P < .001) than did the participants who received "negative" or "normal" results. CONCLUSION Interpretive labels for test results can induce larger changes to a woman's risk perception and behavioral intention than can numeric results alone, which create decision momentum. This finding has broad clinical implications for patient-provider communication.

[1]  J. R. Beekhuis,et al.  The influence of serum screening on the amniocentesis rate in women of advanced maternal age , 1994, Prenatal diagnosis.

[2]  T. Marteau,et al.  Informed consent to undergo serum screening for Down's syndrome: the gap between policy and practice , 1994, BMJ.

[3]  K. Nicolaides,et al.  Evidence-based obstetric ethics and informed decision-making by pregnant women about invasive diagnosis after first-trimester assessment of risk for trisomy 21. , 2005, American journal of obstetrics and gynecology.

[4]  J. Gondry,et al.  Informed consent to serum screening for Down syndrome: are women given adequate information? , 1999, Prenatal diagnosis.

[5]  S. Michie,et al.  Variation in uptake of serum screening: the role of service delivery , 2002, Prenatal diagnosis.

[6]  P. Ubel,et al.  Hope I Die before I Get Old: Mispredicting Happiness Across the Adult Lifespan , 2006 .

[7]  G. van der Wal,et al.  Informed decision making in the context of prenatal screening. , 2006, Patient education and counseling.

[8]  Christopher K. Hsee,et al.  Risk as Feelings , 2001, Psychological bulletin.

[9]  D. Grimes,et al.  Patients' understanding of medical risks: implications for genetic counseling. , 1999, Obstetrics and gynecology.

[10]  T. Marteau,et al.  Lack of knowledge in health professionals: a barrier to providing information to patients? , 1994, Quality in health care : QHC.

[11]  Stephen M. Johnson,et al.  The affect heuristic in judgments of risks and benefits , 2000 .

[12]  S. Michie,et al.  Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women's attitudes or a failure to facilitate informed choices? , 2005, International journal of epidemiology.

[13]  A. Tversky,et al.  Judgment under Uncertainty: Heuristics and Biases , 1974, Science.

[14]  M Bobrow,et al.  Numbers or words? A randomized controlled trial of presenting screen negative results to pregnant women , 2000, Prenatal diagnosis.

[15]  A. Summers,et al.  The influence of risk estimates obtained from maternal serum screening on amniocentesis rates , 2005, Prenatal Diagnosis.

[16]  S. Michie,et al.  Informed choice in antenatal Down syndrome screening: a cluster-randomised trial of combined versus separate visit testing. , 2006, Patient Education and Counseling.

[17]  C. K. Mertz,et al.  PSYCHOLOGICAL SCIENCE Research Article Numeracy and Decision Making , 2022 .

[18]  Gary L. Wells,et al.  Measuring psychological uncertainty: Verbal versus numeric methods , 1996 .

[19]  S. Gregorich,et al.  Erratum: Beyond race or ethnicity and socioeconomic status: Predictors of prenatal testing for Down syndrome (Obstetrics and Gynecology (2006) 107, (1087-1097)) , 2006 .

[20]  T. Marteau,et al.  Presenting a routine screening test in antenatal care: practice observed. , 1992, Public health.

[21]  P. Windschitl,et al.  The influence of reasons on interpretations of probability forecasts , 2003 .

[22]  B. Rimer,et al.  General Performance on a Numeracy Scale among Highly Educated Samples , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[23]  R. Naeem,et al.  Decisions about amniocentesis by advanced maternal age patients following maternal serum screening may not always correlate clinically with screening results: need for improvement in informed consent process. , 2002, American journal of medical genetics.

[24]  S. Michie,et al.  To be reassured or to understand? A dilemma in communicating normal cervical screening results. , 2004, British journal of health psychology.

[25]  S. Gregorich,et al.  Beyond Race or Ethnicity and Socioeconomic Status: Predictors of Prenatal Testing for Down Syndrome , 2006, Obstetrics and gynecology.