The Feasibility and Impact of a Computer-Aided Genetics Education Module in an Obstetrics Clinic: A Randomized Controlled Trial

Abstract

ABSTRACT Background Rapid advances in prenatal genetic testing highlight the need for technology-based tools to assist in informed decision-making. Purpose This study evaluates the feasibility, acceptability, and efficacy of a Computer-Aided Genetics Education Module (CAGEM) as an e-counseling tool and decision aid in a busy obstetric clinic among a socially disadvantaged patient population. Methods A randomized controlled trial with patients randomized (1:1) to receive the intervention in addition to standard of care or standard of care only. Participants responded to pre- and posttest questionnaires. Results Although limited in recruitment by the COVID-19 pandemic, this tool scored 81.0% acceptability and 91.0% feasibility among 88 participants. No statistically significant difference was detected between the overall improvement in knowledge scores and the total posttest knowledge scores among the intervention and control groups. However, the intervention group scored significantly higher on the posttest questions regarding NIPT interpretation (61.7 ± 49.1 vs 80.9 ± 39.8, p = .049), Down syndrome (78.7 ± 41.4 vs 93.6 ± 24.7, p = .016), and inheritance of recessive conditions (59.6 ± 49.6 vs 91.4 ± 28.2, p < .001). The intervention group also showed a greater improvement in knowledge scores for inheritance of recessive conditions (31.9 ± 8.1 vs 0 ± 7.8, p = .006) and a protective effect in knowledge scores for Down syndrome (0 ± 6.1 vs −17.1 ± 6.0, p =.049). Discussion CAGEM may be a feasible and acceptable e-counseling tool and decision aid, especially when compared to standard of care prenatal counseling. Although overall knowledge did not show significant improvement, CAGEM showed promise in enhancing knowledge acquisition for certain genetic education topics, showing that technology-based tools may be beneficial in informed consent. Future iterations may be revised to improve clarity, especially around invasive testing methods, race congruency, and insurance coverage. Translation to Health Education Practice: This study’s method creates a model for Health Educators to design and evaluate technology-based tools for improving informed decision-making around prenatal genetic testing. Tools like CAGEM may be utilized to improve patient education prior to prenatal appointments and thus serve as an adjunct to provider counseling. Specifically, CAGEM addresses multiple NCHEC Responsibilities and Competencies including #1.1.2, 1.3.2, 1.3.4, 4.2.9, and 6.4.3.