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Licensed Unlicensed Requires Authentication Published by De Gruyter April 17, 2020

Women’s decisional conflict in the pathway of prenatal screening and testing: an explorative study within Finnish public maternity care

  • An Chen , Henni Tenhunen , Paulus Torkki , Seppo Heinonen , Paul Lillrank and Vedran Stefanovic EMAIL logo



To explore women’s decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service.


Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statistical tests were used to compare women’s decisional conflict at different medical settings of PreST, and before-after pre-test counseling. Multivariable linear regressions analyzed the influences of the medical settings and other factors on women’s decisional conflict.


Compared to women in population-based screening, women in further testing (before pre-test counseling) were more likely to feel well informed (P < 0.001), had increased values clarity (P < 0.001), but more likely experienced uncertainty (P = 0.040). Besides medical settings, maternal age, gravidity and previous experience of fetal aneuploidy significantly influenced decisional conflict. After counseling, screen-positive women felt better informed (P < 0.001), had increased values clarity (P < 0.001), perceived more support (P < 0.001), and had better decision certainty (P < 0.001) than before counseling.


Medical settings influence women’s decisional conflict during PreST. Individual counseling is effective in improving screen-positive women’s decisional conflict. This research adds knowledge and experience on developing decision-making supports across the pathway of PreST.

Corresponding author: Vedran Stefanovic, PhD, MD, Professor of Obstetrics, Gynecology and Fetal Medicine, Senior Consultant, Senior Lecturer, Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland


The work reported here was highly supported by the staff of the Fetomaternal Medical Center and delivery hospitals in Helsinki. Special gratitude is owed to Ms. Satu Leminen, Ms. Minna Richards and Ms. Maaria Puupponen. Ms. Eija.Raussi-Lehto and Mr. Antti Niemi from Helsinki Metropolia University of Applied Sciences made great contributions to the research.

  1. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  2. Research funding: This paper was financially supported by Aalto University, Helsinki University Hospital and TEKES (Business Finland).

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: This study was approved by the HUS Ethical Committee (permission number: 220/13/03/03/2015).

  6. Data availability statement: The dataset generated and analyzed for this study is not publicly available due to the restrictions claimed in the document of the HUS (The Hospital District of Helsinki and Uusimaa) research permission. But the data are available from the HUS Committee for researchers who meet the criteria for access to confidential data. For requesting the access to quantitative data, please contact HUS Surgery and Ethics Committee for gynaecology and obstetrics, pediatrics and psychiatry. Presenting Official: Heli Nevanlinna, p. +358 9 4717 1750. Office Secretary: Piia Paavilainen, p. +358 504 279 493. For concerning other issues related to the quantitative data, please contact Dr. Vedran Stefanovic (, who is one of the authors of the manuscript.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2019-12-07
Accepted: 2020-03-23
Published Online: 2020-04-17
Published in Print: 2020-07-28

©2020 Walter de Gruyter GmbH, Berlin/Boston

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