Women’s preferences for antenatal screening for Downsyndrome in Northern Ireland: a choice experiment

Bernie Reid, Marlene . Sinclair, Owen Barr, Frank Dobbs, Grainnne crealey

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Despite an increasing international trend towards the implementation of antenatal screening programmesfor Down syndrome, there is currently limited information relating to women’s choices or preferences for such screening.Information about women’s preferences for and insight into the potential value they may derive from any change to screeningprogramme design are essential components of evidence-based policy decision-making. This paper reports on a choiceexperiment undertaken to examine the preferences of a sample of pregnant and non-pregnant women of childbearing agewith respect to antenatal screening for Down syndrome in Northern Ireland, where the offer of screening is not universal andselective abortion on the grounds of fetal abnormality is legally inaccessible.Method. The choice experiment was conducted using an internet-based survey to obtain the preferences of a volunteer sampleof 50 pregnant and 73 non-pregnant women for screening tests that varied according to six test characteristics or attributesderived from an earlier focused ethnographic study. These attributes were: source of screening information, time of testin pregnancy, accuracy of test results, cost of test as an ‘out of pocket’ expense, waiting time for test results, and risk ofmiscarrying a baby unaffected by Down syndrome as a result of subsequent diagnostic testing.Results. Pregnant and non-pregnant women prefer screening tests for Down syndrome offering results with accuracy levelsof 90% and above, and where the risk of subsequent diagnostic procedure-associated miscarriage is 2% and below. Womenpreferred screening tests offering more accurate results over no risk of miscarriage. Pregnant women place more value thannon-pregnant women on tests carried out during the first trimester.Conclusion. Policies for the implementation of antenatal screening programmes for Down syndrome must consider thepreferences of pregnant and non-pregnant women to ensure that the needs of current and potential future service users aremet. Effective pre-test counselling is essential to ensure that women understand the attributes of any screening test and itspossible implications.
Original languageEnglish
Pages (from-to)112-120
JournalEvidence Based Midwifery
Volume12
Issue number4
Publication statusPublished - Dec 2014

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Keywords

  • Choice experiment
  • Down syndrome
  • screening
  • women’s preferences
  • evidence-based midwifery

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