Patient Decision Aids for Prenatal Genetic Testing: Probability, Embodiment, and Problematic Integration Russell Kirkscey a a Department of English, Texas Tech University ABSTRACT Patient decision aids (PDAs) are documents that attempt to support patient participation in biomedical decision making by discussing information and options. Scholars have called for further elaboration and application of communication theory relating to the construction and uses of PDAs. This article analyzes gateway documents, a genre of PDAs that includes texts from noncommercial websites returned during an initial inquiry for decision-making information. Problematic integration theory informs and extends a meaning of balance in a sample of four PDAs for prenatal genetic testing. The study addresses several communication opportunities, including discussions of benefits, disadvantages, providers’ scientific knowledge, and patients’ embodied knowledge. The PDA authors’ emphases on statistical risk without more inclusive considerations of embodied knowledge highlight a conclusion that the documents in the sample are imbalanced. This research serves to introduce a theoretical communication context for analysis of PDAs that may assist scholars in further contributions to the interdisciplinary field of biomedical communication. Shared decision making (SDM) is becoming an integral part of patient–provider communication (Holmes-Rovner & Rovner, 2009). Based in part on increased patient autonomy and evidence-based medicine, SDM seeks to provide informa- tion and choices so that caregivers and care seekers may explore treatment options to create patient satisfaction and increased quality of life (Andorno, 2004; Edwards & Elwyn, 2009). Important tools for SDM are patient decision aids (PDAs), documents that attempt to support patient participa- tion by discussing the information and options necessary for ideal decision making in biomedical situations (Volk & Llewellyn-Thomas, 2012). The International Patient Decision Aid Standards (IPDAS) Collaboration has created guidelines for bioethically sensitive PDAs, including presentation of probabilities, lack of bias, discussion of patient values, balanced information, treatment choices, and simple language (O’Connor & Llewellen-Thomas, 2005). Scholars have called for further theorization of PDAs, especially in the field of communication. Street (2007) argued, “From a communication perspective, much remains to be done. Communication skills training for patients and clinicians are rare in decision aid research” (p. 552). Elwyn, Frosch, Volandes, Edwards, and Montori (2010) noted, “Theories about communi- cation are not adequately considered in this field yet we know that the deliberation that occurs between patients and their health care professionals is a key component of effective decision support” (p. 709). In particular, IPDAS Collaboration criteria demanded an equal presentation of benefits and disadvantages: “The extent to which a decision aid is ‘balanced’ is the extent to which it presents —in content, in format, and in display—the available options and the positive and negative information about each of those options in a complete and neutral manner” (Stalmeier et al., 2012, p. 2). The theory of problematic integration (PI) (Babrow, 1992, 2001, 2007) provides criteria that can assist in describing the balance of scientific probabilities associated with biomedicine and patient values associated with embodied knowledge in bio- medical decision making. Accordingly, this article responds to calls for further communication research on PDAs in two ways: (a) by extending PI theory to elaborate the meaning of balance and (b) by applying this definition as a rhetorical framework to a sample of PDAs for prenatal genetic testing. The analysis explored the following research question: Does a sample of PDAs achieve balanced argumentation for and against prenatal genetic testing? Problematic Integration and Patient Decision Aids in Health Communication and Medical Rhetoric Scholars in health communication and medical rhetoric have used PI theory in a variety of ways, many of which highlight the argument that people attempt to integrate their life experiences with knowledge gained through communication with biomedical practitioners. Risk themes and reward themes dominated focus groups of women who discussed prenatal diagnostic testing, revealing both convergence and divergence of probabilities and evaluations, respectively (Dorgan, Williams, Parrott, & Harris, 2003). Women and their relations who experienced or imagined breastfeeding failures described divergence between probabilistic and evaluative orientations (Koerber, Brice, & Tombs, 2012). The inability of laypeople to integrate scientific and spiritual-based epistemologies may cause divergence through increased CONTACT Russell Kirkscey russell.kirkscey@ttu.edu Department of English, Texas Tech University, PO Box 43091, Lubbock, TX 79409-3091. HEALTH COMMUNICATION http://dx.doi.org/10.1080/10410236.2016.1140500 © 2016 Taylor & Francis