How women understand and use a tool to predict early pregnancy outcome: A qualitative analysis.

Objective: To explore how women, understand, interpret and use a validated individualised early pregnancy outcome prediction score tool.

Methods: Qualitative interview study nested within a larger quantitative randomised controlled trial (RCT) within the Early Pregnancy Unit of a London teaching hospital. Women with an ultrasound diagnosis of an early intrauterine pregnancy of uncertain viability (PUV) were randomised to receive a validated outcome prediction score or routine care. Those who received the prediction were invited to interview. Thematic analysis was conducted with a focus on women's experiences of receiving the prediction model. The study was complete when no further themes emerged.

Results: Eleven interviews were completed. Five themes emerged from the data: 1) Credibility, 2) Setting Expectations, 3) Sharing, 4) Reflecting and 5) Risks. Scientific development of the tool and delivery by a healthcare professional lent credibility. Women mostly found the prediction tool helpful in anticipating and preparing for the actual outcome. Women largely did not share their prediction outside immediate family. Where women perceived that the tool did not take sufficient account of individual previous experience, less value was attributed. Women also believed in a potential psychological risk from a high prediction of viability being followed by a poor outcome.

Conclusions: This study presents a nuanced understanding of women's use of an outcome prediction tool, which is not found from standard quantitative data. Recognising how women rationalise and use information is as important as statistical performance of a tool when implementing supportive care interventions. Whilst the results give better understanding in cases of PUV, it is not known whether the findings can be generalised to other early pregnancy scenarios.