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120 ‘Gaming’ the system to improve decision making for prenatal screening
  1. Erin Phinney Johnson1,
  2. Naomi Riches1,
  3. Amanda Allshouse1,
  4. Neeta Vora2,
  5. Akila Subramanian3,
  6. Erin Rothwell1
  1. 1Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, USA
  2. 2Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, USA
  3. 3Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, USA


Introduction Cell-Free DNA testing (cfDNA) screens for genetic differences during pregnancy and is recommended by the International Society for Prenatal Diagnosis (ISPD) and the American College of Obstetricians and Gynecologists (ACOG) as the first line screening test. Many providers do not provide preliminary counseling about cfDNA due to time, knowledge, or other constraints. Patient decisions are heavily influenced by how the provider presents options and information. Genetic counselors have specialized training, but due to the limited number of counselors, appointments are not universally feasible, especially in rural settings. This study compares an online gamified decision aid to genetic counseling for pre-test education about prenatal screening. Outcomes measured included knowledge, decisional conflict, and shared decision making. We also collect data from the pregnant person’s partner, when available, to assess the power of partnership on this decision-making process.

Methods Participants from three US hospital systems are recruited prior to their first visit for a new pregnancy and randomized into three groups to provide education about cfDNA: brochure only (standard of care), genetic counseling, or a game (online interactive decision aid). Recruitment began on April 17, 2023. Surveys are provided to participants and their partners pre- and post-cfDNA screening decision and at 20-weeks gestation.

Results We will present the protocol and preliminary descriptive statistics by randomization group and partner involvement, as well as participant knowledge, shared decision making, and decisional conflict scores for Year 1 of the study. Additionally, we will explore participant and partner engagement with the two experimental conditions.

Discussion/Conclusion The decision to undergo prenatal genetic screening can have far reaching impacts on the families involved. This study will expand what we know about how the type of patient education impacts shared decision making and about how partners contribute to these decisions.

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