Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals

Abstract

Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants' stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women's and 1245 health professionals' questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women's and health professionals' preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.

Figure 1

Design of the discrete choice experiment. (a) Attributes and levels used in the discrete choice experiment. (b) Example of a discrete choice experiment choice set.

Figure 2

Probability that women and health professionals from each country would choose the tests from the choice sets that most closely resemble NIPT or IPD.

Figure 3

Direct choice between test 1 (NIPT), test 2 (IPD) and no test. (a). Women's preferred test for Down syndrome. (b). Health professional's preferred test for Down syndrome.