Verp M S, Heckerling P S
Department of Obstetrics and Gynecology, University of Chicago, IL 60637, USA.
Am J Med Genet. 1995 Sep 25;58(4):337-44. doi: 10.1002/ajmg.1320580407.
Women with a family history of a chromosomal or genetic abnormality must weigh several factors in choosing between amniocentesis and chorionic villus sampling. We compared the prenatal test choices of three such women with those of decision analytic models that incorporated their preferences. Patient preferences were assessed using visual linear rating scales. Threshold analysis was used to determine preference ranges, and stochastic sensitivity analysis to provide confidence levels, for each choice of test. The test choices of patients and decision analytic models agreed in one case, and disagreed in two cases. In one of the latter two cases, stochastic and threshold analyses showed the disagreement to be slight; for small shifts in preference differences for first- vs. second-trimester diagnosis, or first- vs. second-trimester therapeutic abortion, patient and decision model would have agreed. In the other, stochastic analysis showed their differences to be large; there were no thresholds for early diagnosis, or for early therapeutic abortion, that would have led to agreement between patient and model. In the two cases in which patient and decision model agreed or slightly disagreed, the patients had made their own choice of prenatal test. In the case in which patient and decision model strongly disagreed, the patient's physician had shared in the choice of test. Decision analysis can be useful in analyzing prenatal test choices based on individual preferences for pregnancy outcomes. When choices of patients and decision models do not agree, examination of the locus of decision making (patient vs. physician) may help resolve apparent differences.
有染色体或基因异常家族史的女性在选择羊膜穿刺术和绒毛取样时必须权衡几个因素。我们将三位此类女性的产前检测选择与纳入她们偏好的决策分析模型的选择进行了比较。使用视觉线性评定量表评估患者的偏好。阈值分析用于确定每种检测选择的偏好范围，随机敏感性分析用于提供置信水平。患者和决策分析模型的检测选择在一个案例中一致，在两个案例中不一致。在后两个案例中的一个案例中，随机分析和阈值分析表明分歧较小；对于孕早期与孕中期诊断或孕早期与孕中期治疗性流产的偏好差异的微小变化，患者和决策模型本会达成一致。在另一个案例中，随机分析表明他们的差异很大；对于早期诊断或早期治疗性流产，不存在会导致患者和模型达成一致的阈值。在患者和决策模型一致或略有分歧的两个案例中，患者自行选择了产前检测。在患者和决策模型强烈分歧的案例中，患者的医生参与了检测选择。决策分析有助于根据对妊娠结局的个人偏好分析产前检测选择。当患者和决策模型的选择不一致时，检查决策制定的场所（患者与医生）可能有助于解决明显的差异。
