Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial

Hersch, Jolyn; Barratt, Alexandra; Jansen, Jesse; Irwig, Les; McGeechan, Kevin; Jacklyn, Gemma; Thornton, Hazel; Dhillon, Haryana M.; Houssami, Nehmat; McCaffery, Kirsten

doi:10.1016/s0140-6736(15)60123-4

Cited by 255 publications

(354 citation statements)

References 36 publications

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“…as used by Smith et al 15 and Hersch et al 16 ) improve comprehension, including among people with low literacy and numeracy.…”

Section: Supporting Informed (Shared) Decision Making With Decision Aidsmentioning

confidence: 99%

Improving communication about cancer screening: moving towards informed decision making

Hersch¹,

Nickel²,

Ghanouni³

et al. 2017

Public Health Res Pract

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For decades, public communications about cancer screening have used persuasive techniques with the aim of maximising the number of people being screened. However, perspectives have changed more recently to acknowledge that screening can lead to harm as well as benefit, and that it is important for service users to consider both. For some types of cancer screening, there is professional contention about whether benefits clearly outweigh harms. In light of this, an emerging trend in cancer screening communication is to try to support informed decision making -that is, to help people understand both the advantages and disadvantages of screening, allowing them to make individual decisions about their screening participation that reflect their informed preferences. In this review, we provide an overview of key theoretical and practical aspects of improving communication and supporting informed decision making about cancer screening, highlight relevant research and discuss future implications.

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“…as used by Smith et al 15 and Hersch et al 16 ) improve comprehension, including among people with low literacy and numeracy.…”

Section: Supporting Informed (Shared) Decision Making With Decision Aidsmentioning

confidence: 99%

Improving communication about cancer screening: moving towards informed decision making

Hersch¹,

Nickel²,

Ghanouni³

et al. 2017

Public Health Res Pract

Self Cite

View full text Add to dashboard Cite

show abstract

“…A more balanced communication of potential benefits and harms facilitates informed choice, where individuals make their own decision about participating in screening. 4 There is arguably an ethical imperative to provide evidence about benefits and harms of screening to potential participants, and to policy makers who must choose between different population health strategies within budgetary constraints. Dead at age 70…”

Section: Communication Of Cancer Screeningmentioning

confidence: 99%

Assessing the efficacy of cancer screening

Jacklyn

Bell

Hayen

2017

Public Health Res Pract

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Background: Population-based cancer screening has been established for several types of cancer in Australia and internationally. Screening may perform differently in practice from randomised controlled trials, which makes evaluating programs complex. Materials and methods:We discuss how to assess the evidence of benefits and harms of cancer screening, including the main biases that can mislead clinicians and policy makers (such as volunteer, lead-time, length-time and overdiagnosis bias). We also discuss ways in which communication of risks can inform or mislead the community. Results:The evaluation of cancer screening programs should involve balancing the benefits and harms. When considering the overall worth of an intervention and allocation of scarce health resources, decisions should focus on the net benefits and be informed by systematic reviews. Communication of screening outcomes can be misleading. Many messages highlight the benefits while downplaying the harms, and often use relative risks and 5-year survival to persuade people to screen rather than support informed choice.Lessons learned: An evidence based approach is essential when evaluating and communicating the benefits and harms of cancer screening, to minimise misleading biases and the reliance on intuition.

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“…Another way of providing the same information would be to use absolute risk rates and to say that if one screens 1000 women for 20 years, four breast cancer deaths can be averted, even though eight among all screened women still die from breast cancer. In addition, over the 20 years, the 1000 women taking part in screening experience 412 false positives, and of 73 women who are diagnosed with breast cancer, 19 experience overdetection and are treated for a cancer that would not have developed into a lethal tumor, with treatment typically consisting of hormone-radio-or chemo-therapy, and partial or full surgical breast-removal (Hersch et al 2015 ). This way of presenting data ( Fig.…”

Section: Formal and Informal Health Workersmentioning

confidence: 99%