Patient or physician preferences for decision analysis: The prenatal genetic testing decision

The choice between amniocentesis and chorionic villus sampling for prenatal genetic testing involves tradeoffs of the benefits and risks of the tests. Decision analysis is a method of explicitly weighing such tradeoffs. The a uthors examined the relationship between prenatal test choices made by pati ents and the choices prescribed by decision-analytic models based on their preferences, and separate models based on the preferences of their physicia ns. Preferences were assessed using written scenarios describing prenatal t esting outcomes, and were recorded on linear rating scales. After adjustmen t for sociodemographic and obstetric confounders, test choice was significa ntly associated with the choice of decision models based on patient prefere nces (odds ratio 4.44; CI, 2.53 to 7.78), but not with the choice of models based on the preferences of the physicians (odds ratio 1.60; CI, 0.79 to 3 .26). Agreement between decision analyses based on patient preferences and on physician preferences was little better than chance (kappa = 0.085 +/- 0 .063). These results were robust both to changes in the decision-analytic p robabilities and to changes in the model structure itself to simulate non-e xpected utility decision rules. The authors conclude that patient but not p hysician preferences, incorporated in decision models, correspond to the ch oice of amniocentesis or chorionic villus sampling made by the patient. Nev ertheless, because patient preferences were assessed after referral for gen etic testing, prospective preference-assessment studies will be necessary t o confirm this association.