Understanding Patient Choice: A Study of Women’s Choice in Prenatal Screening and Testing

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School of Science | Doctoral thesis (article-based) | Defence date: 2017-12-15
Degree programme
97 + app. 93
Aalto University publication series DOCTORAL DISSERTATIONS, 212/2017
With the megatrends of autonomy and individual empowerment in health care, patient choice becomes an essential part of improving health care quality and appears as a health care policy in many developed countries. Patients are endowed with increased opportunities to choose and decide according to their own preferences. However, patient choice comes with controversy and complexity. A large amount of evidence has shown that patient choice does not always produce positive effects. The big problem we have to face and address in an urgency is how to manage patient choice in an optimal way. Over the recent decades, a great effort has been made to understand patient choice and design appropriate choice interventions to achieve desired outcomes. However, there is a lack of contextual awareness in the existed research and little attention has been paid to the patient's experience in choice-making process. This dissertation advances the understanding on patient choice by contextualizing patient choice and exploring patient experience in choice-making processes within certain contexts. It aims to provide possible solutions for optimizing patient choice and improving patient satisfaction with the choice. This dissertation based on four articles took a pragmatic view and applied a mixed-method case study approach. The study undertook an in-depth investigation on women's choice in the prenatal screening and testing implemented in the Hospital District of Helsinki and Uusimaa (HUS) in Finland. Qualitative data were collected by reading relevant documents and interviewing pregnant women and the medical staff from maternal clinics, delivery hospitals, and the Fetomaternal Medical Center (FMC). Quantitative data were obtained by accessing the prenatal testing choice database at FMC and conducting a cross-sectional self-completion survey. This study found that contextual factors, e.g. service schedules and arrangement, were important for patients to make choices. It applied Demand-Supply based Operating logic to contextualize patient choice and showed that at different contexts patients had different choice-making processes in terms of activeness, preferences or considerations, information needs and sources, social influence, emotion status and choice-making difficulty. This dissertation also developed a set of measurements to quantify and evaluate patient experience in choice-making processes and identified experiential factors that significantly influence patient satisfaction with the choices the patient made. The combination of the four articles can provides an insight into how to systematically construct possible choice architectures and design appropriate choice aids. Especially, it highlights the role of context in organizing health services and studying patient choices. It also contributes to the practices of communicating with patients who are suffered from unexpected situations and assisting them in arriving at a satisfying choice.
Supervising professor
Lillrank, Paul, Prof., Aalto University, Department of Industrial Engineering and Management, Finland
Thesis advisor
Torkki, Paulus, Associate Prof., University of Helsinki, Finland
Stefanovic, Vedran, Prof., Helsinki University Hospital and University of Helsinki, Finland
patient choice, contextualization, experience, management, choice architecture
Other note
  • [Publication 1]: Chen, An., Tenhunen, Henni., Torkki, Paulus., Heinonen, Seppo., Lillrank, Paul., Stefanovic, Vedran. 2016. Women's choices for invasive or non-invasive testing: influence of gestational age and service delivery. Prenatal Diagnosis, 36(13), 1217-1224. ISSN: 1097-0223.
    DOI: 10.1002/pd.4960 View at publisher
  • [Publication 2]: Chen, An., Tenhunen, Henni., Torkki, Paulus., Heinonen, Seppo., Lillrank, Paul., Stefanovic, Vedran. 2017. Considering medical risk information and communicating values: A mixed-method study of women’s choice in prenatal testing. PlOS ONE, 12(3). eISSN: 1932-6203. Full text at Aaltodoc: http://urn.fi/URN:NBN:fi:aalto-201704203641.
    DOI: 10.1371/journal.pone.0173669 View at publisher
  • [Publication 3]: Chen, An., Tenhunen, Henni., Torkki, Paulus., Peltokorpi, Antti., Heinonen, Seppo., Lillrank, Paul., Stefanovic, Vedran. Facilitating autonomous, confident and satisfying choices: A mixed-method study of women’s choice-making in prenatal screening for common aneuploidies. Submitted manuscript, 31 pages.
  • [Publication 4]: Chen, An., Lillrank, Paul., Tenhunen, Henni., Peltokorpi, Antti., Torkki, Paulus., Heinonen, Seppo., Stefanovic, Vedran. 2018. Context-based patient choice management in healthcare. International Journal of Health Care Quality Assurance, 31 (1). Forthcoming.