Abstract Objective To assess the extent to which family physicians (FPs) involve women in decisions about prenatal screening for Down syndrome. Methods Based on transcripts of consultations between 41 FPs and 128 women, two raters independently assessed clinician's efforts to involve women in decisions about prenatal screening for Down syndrome using the French‐language version of OPTION. Descriptive statistics of OPTION scores were calculated. Construct validity was assessed by performing a principal factor analysis and by measuring association with consultation duration and FPs sociodemograhics. Internal consistency was assessed with Cronbach's alpha and inter‐rater reliability with the intraclass correlation coefficient. Results The overall mean OPTION score was low: 19 ± 7 (range = 0 [no involvement] to 100 [high involvement]). One factor accounted for 80% of the variance. Both internal consistency and inter‐rater reliability were very good (Cronbach's alpha = 0.73; ICC = 0.76). OPTION scores were lower for residents than for licensed FPs (17 ± 5 vs 21 ± 4; p = 0.02) and were positively associated with duration of consultation ( r = 0.56; p < 0.001). Conclusion Based on the French‐language version of OPTION, which showed satisfactory psychometric properties, FPs studied put minimal efforts to involve women in decisions about prenatal screening for Down syndrome. Copyright © 2009 John Wiley & Sons, Ltd.