Table 1 A selection of citations from the focus group meetings

1

“It is a completely different story if a woman had a previous stillbirth or if the woman is happily pregnant and seeing a midwife.” (FG 1)

2

“If we have frightened patients, like DES-daughters with increased risk for clear cell carcinoma, it is hard to convince them that they are not at risk anymore at a certain age.” (FG 3)

3

“You have the risk of false positive test results (…) you know that causes anxiety.” (FG 3)

4

“An image is much more illustrative for patients. (…) it is nicer for patients to see it themselves directly than to interpret a lab result, how would they know what a normal result is?” (FG 4)

5

“You can say either ‘I don’t see anything wrong’ or you can say ‘everything looks absolutely marvelous’. It is all subjective; it depends on how you wrap the message.” (FG 2)

6

“That woman goes through a rough time, and I am not willing to talk about it for 30 minutes each week. But she will be able to talk to a nurse during a CTG (…) and she will be happy about the good results.” (FG 1)

Throughput: perception

7

“If a patients feels fatigued but the hemoglobin is normal, it illustrates that there must be another cause for their fatigue than anemia.” (FG 7).

8

“This woman received palliative treatment for metastasized ovarian cancer. But she used tumor markers as a measurement of her health, irrespectively of whether she felt healthy or sick.” (FG 3).

9

“By giving a diagnosis, you show patients that they are not to blame for developing the illness.” (FG 4)

10

“I think many patients want a label for their disease, to help them feel in control again. (…) that can really help a patient.” (FG 5).

11

“I do the test to convince the patient that her vaginal discharge is normal, she wouldn’t accept it as being normal without a test (…) then she wouldn’t have felt taken seriously.” (FG 9)

12

“The chance that a patient will go to a different hospital increases if we withhold from any medical test.” (FG 1)

Output: patient outcomes

13

“A test that can give much reassurance is the cervical length measurement. (…) Patients attach a large amount of importance to that result, so if you give them the length measurement and it is large enough, they are okay again for a while.” (FG 8)

14

“I have a patient who is finally diagnosed with endometriosis. This diagnosis alone can give a bit of peace and helps to cope with the complaints, because now the patient knows what causes the complaints for a fact, and that gives her comfort.” (FG 7)

15

“You have to be careful in performing tests for reassurance, this can undermine patients’ confidence that things will turn out all right by themselves. Then they might need a reassuring test for every little symptom!” (FG 5)

16

“A glucose control can be very confronting for a woman with diabetes; they might skip the next piece of cake.” (FG 6)

17

“Even if you find no impairment caused by smoking, it might still kill her if she continues. But her smoking behavior can be strengthened by the test, because she might reason that the test result shows that she is immune for the negative effects of smoking.” (FG 7)

18

“For example, if a woman has anemia, but she dislikes iron tablets, then you can order a hemoglobin test to motivate her to continue the tablets. You can say that her hemoglobin value has improved, but has not yet recovered…” (FG 4)

19

“If you can reassure people about certain things, some people perceive less pain or have fewer complaints. It is a sort of homeopathic principle.” (FG 3)

20

“Even a normal cyst can make people ill (…) they will develop abdominal pain immediately.” (FG 7)