Eliciting Health Professionals’ Salient Beliefs about the Use of a Patient Decision Aid in the Context of Prenatal Screening for Trisomy 21

Johanie Lépine1, Maria-Esther Leiva-Portocarrero1, Agathe Delanoë1, Hubert Robitaille1, Isabelle Lévesque2, Brenda Wilson3, Anik Giguère4 and France Légaré1,5

1. Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada; 2. Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada; 3. Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada; 4. Centre d’excellence sur le vieillissement de Québec, CHU de Québec Research Centre, Quebec, Canada; 5. Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada

Background: Prenatal screening is a common practice in most industrialized countries, and many tests are now offered to pregnant women. Health professionals are expected to engage pregnant women in shared decision making (SDM) and support them in making informed values-based decisions. Using a patient decision aid (PtDA) could promote SDM in clinical practice. Therefore, we sought to elicit health professionals’ salient beliefs about using a PtDA in the context of prenatal screening for trisomy 21 (T21, Down Syndrome).

Methods: We recruited family physicians in a family practice teaching unit, midwives in a birthing centre and obstetricians-gynecologists in a university hospital in Quebec city, Quebec, Canada. We aimed for a sample of 45 participants (15 in each group). First, we invited participants to view a video showing a health professional using a PtDA about prenatal screening for T21 during a clinical consultation with a pregnant woman and her partner. We then conducted individual interviews with participating health professionals using an interview grid based on the Theoretical Domains Framework (TDF). We asked participants their views about PtDA use for T21 screening during a clinical consultation with a pregnant woman. Open-ended questions pertained to the following constructs: attitude, subjective and descriptive norms, perceived behavioral control, knowledge, emotions, incentives and anticipated regret. We performed a thematic analysis of salient beliefs using N-Vivo software.

Results: Out of 77 potentially eligible health professionals, 36 completed interviews. Interviews and verbatim analyses with family physicians are completed (n=15). Interviews are ongoing with midwives (n=12 completed) and obstetricians-gynecologists (n=9 completed). Preliminary analyses indicate that within each theory-based construct, salient beliefs most frequently reported by family physicians about PtDA use were as advantage: support tool for patient education, 57%, and disadvantage: takes too much time to present, 54% (attitude); people in favour: colleagues, 45%, and people not in favour: colleagues, 50% (subjective norms); positive opinion, 50% (descriptive norm); facilitator: should be presented before consultation by a prenatal nurse, 28%, and barrier: restricted time during consultation, 65% (perceived behavioral control); not knowing about PtDA, 69% (knowledge); stress, 74% (emotion); PtDA availability in consultation office, 29% (incentive); and regret if didn’t use it, 40%, or no regret if didn’t use it, 40% (anticipated regret).

Conclusion: The identification of health professionals’ salient beliefs is the first step toward the design of an effective training program in SDM which could foster increased adoption of a PtDA about prenatal screening for T21 in routine practice.