Nudging in screening: Literature review and ethical guidance

Hofmann, Bjørn; Stanak, Michal

doi:10.1016/j.pec.2018.03.021

Cited by 34 publications

(30 citation statements)

References 114 publications

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“…Additionally, we also used this question to gain a better understanding of how this nudge would facilitate or undermine people’s ability to make an informed choice about screening. Nudge type interventions such as social norms interventions have been criticized in terms of informed decision making [27–29]. As interventions should avoid being manipulative or paternalistic to enable people to make an informed choice based on knowledge of the harms and benefits of cancer screening, it is important to know whether nudges influence information seeking behaviour.…”

Section: Introductionmentioning

confidence: 99%

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

et al. 2019

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Background Studies have shown that presenting correct information about group norms to correct misperceptions of norms can influence health behaviours. In two online studies we investigated how different ways of communicating the current uptake of 43% of the English Bowel Scope Screening (BSS) programme affects intention among disinclined men and women. Methods In the first study, 202 participants were asked to interpret eight quantifiers for 43% uptake (‘ few’ , ‘ many’ , ‘a considerable number’ , ‘ a large number’ , ‘ a great number’ , ‘ a lot’ , ‘ numerous’ and ‘ nearly half’ ) and to indicate how misleading they perceived each of them to be. In the second study, with 1245 participants, we compared the motivational impact of two quantifiers (‘ a large number’ and ‘ nearly half’ which were associated with the highest perceived uptake (48.9%) and considered least misleading in study 1 respectively) with a control message that did not contain any information on uptake, and a message which communicated actual uptake as a proportion (43%). Results While we found that both verbal quantifiers increased screening intentions compared with the control group (from 7.8 to 12.5%, aOR 1.72; 95%CI 1.00–2.96 in the case of ‘ a large number’ and 14.3% , aOR 2.02; 95%CI 1.20–3.38 for ‘ nearly half’ ), simply communicating that 43% do the test, however, had no impact on intentions (9.9% vs. 7.8% aOR 1.25; 95%CI 0.73–2.16). Conclusion Verbal quantifiers can be used to improve the perception of low uptake figures and avoid a demotivating effect. Electronic supplementary material The online version of this article (10.1186/s12889-019-6997-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

et al. 2019

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“…Written information is generally the main or only way that invitees learn about screening in organised programmes. 6,7 However, there may be opportunities to increase perceived acceptability of reduced-frequency risk-stratified breast screening, using subtle methods of designing information that still respect these requirements.…”

Section: Introductionmentioning

confidence: 99%

“…Previous research has found that preferences and perceptions can be influenced using a wide range of psychological methods, and in diverse healthcare contexts and clinical groups. 8 Authors of screening information materials necessarily decide whether to summarize benefits of screening before risks, or vice versa, 6 and this order may have psychological effects. 8 A study of genetic testing for breast cancer risk found that participants had more positive attitudes and intentions (but greater risk perceptions and fewer disadvantages) when advantages were presented before disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of risk-stratified breast screening: Effect of the order of presenting risk and benefit information

et al. 2019

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Objective To test whether reduced-frequency risk-stratified breast screening would be perceived more favourably by transposing the order of information on benefits and risks. Methods After reading vignettes describing non-stratified three-yearly screening and a risk-stratified alternative with five-yearly invitations for women at low risk, 698 women completed an online survey. Participants were allocated at random to information on screening benefits followed by risks, or vice versa, and asked to state preferences for either screening system. Participants also rated perceived magnitude of screening benefits and risks, and breast cancer susceptibility. Results Binomial logistic regression did not find order effects on preferences (p = 0.533) or perceived benefits of screening (p = 0.780). Perceived screening risks were greater when risks were presented first (p < 0.0005). Greater perceived susceptibility was associated with lower proportions preferring risk-stratified screening (15% vs. 39% in highest and lowest groups; p = 0.002), as were greater perceived screening benefits (e.g. 13% vs. 45% in highest and lowest groups; p < 0.0005). Conclusions No information order effect on preferences was observed. Information order did affect screening risk perceptions. Efforts to improve perceptions may need to be more intensive than those tested. Women perceiving themselves as high risk or perceiving greater benefits of screening may be particularly averse to less frequent screening.

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“…As we have seen, the issue of informing about screening touches on general debates on irrational aspects of decision-making, 93 cognitive and affective biases and heuristics, 94 and free will. It has also been argued that nudging can be acceptable 95 and even commendable for some types of screening 96 (although not for mammographic screening).…”

Section: Framing Bias and The Informed Choice Modelmentioning

confidence: 99%

Informing about mammographic screening: Ethical challenges and suggested solutions

Hofmann

2019

Bioethics

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Providing high quality and user oriented information about mammographic screening is no easy task, as screening has been subject to heated professional and public debates. Although the information has to be developed and provided in context for each screening program, the basic challenges are very much the same for all programs. Accordingly, the objective of this article is to analyze key ethical challenges in informing about mammographic screening, and based on these, to suggest some guiding principles for practical solutions. A literature review identifies five crucial issues with respect to informing women about mammographic screening. By analyzing and addressing these issues, five guiding principles are suggested: the content and the form of information should be developed through open and transparent processes with strong stakeholder involvement. Facts should be presented in a balanced way and uncertainties should be acknowledged, e.g., by presenting outcomes in ranges. Information should be layered without attempts to frame information. Attending mammographic screening should be as easy as not attending. Although apparently trivial, the suggested principles can be useful for elaborating specific information material about mammographic screening in a field of great ethical controversy.

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Nudging in screening: Literature review and ethical guidance

Cited by 34 publications

References 114 publications

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

Acceptability of risk-stratified breast screening: Effect of the order of presenting risk and benefit information

Informing about mammographic screening: Ethical challenges and suggested solutions

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