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Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability

Miron-Shatz, Talya and Rapaport, Sivan R and Srebnik, Naama and Hanoch, Yaniv and Rabinowitz, Jonina and Doniger, Glen M and Levi, Linda and Rolison, Jonathan J and Tsafrir, Avi (2018) 'Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability.' Journal of Genetic Counseling, 27 (1). pp. 59-68. ISSN 1059-7700

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Funding policy and medico-legal climate are part of physicians’ reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician’s assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N = 171) completed a questionnaire and provided amniocentesis recommendations for women at 18 weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger (‘yes’ regardless of testing results: 6.4%; ‘no’ regardless of testing results: 31.6%) versus older woman (‘yes’ regardless of testing results: 40.9%; ‘no’ regardless of testing results: 7.0%; χ2 = 71.55, p < .01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians’ recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician’s assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence.

Item Type: Article
Uncontrolled Keywords: Decision making; Prenatal testing; Clinician recommendation; Bias; Maternal age; Amniocentesis; Defensive medicine; Funding policy
Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Science and Health
Faculty of Science and Health > Psychology, Department of
SWORD Depositor: Elements
Depositing User: Elements
Date Deposited: 21 Jul 2017 14:46
Last Modified: 06 Jan 2022 14:47

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