Do invitations for cervical screening provide sufficient information to enable informed choice? A cross-sectional study of invitations for publicly funded cervical screening

Abstract

SummaryObjective: To investigate whether invitations for publicly funded cervical screening provide sufficient information to enable an informed choice about participation. Design: Cross-sectional study using a checklist of 23 information items on benefits and harms from cervical screening and the risks related to cervical cancer. Material: Invitations to publicly funded cervical screening in 10 Scandinavian and English-speaking countries. Setting: Ten Scandinavian and English speaking countries. Participants: Sixteen screening units representing 10 Scandinavian and English speaking countries. Main outcome measures: Number of information items presented in invitations for cervical screening. Results: We contacted 21 coordinating units from 11 countries and 20 (95%) responded. Of these, four units did not issue invitations, but the remaining 16 coordinating units in 10 different countries supplied a sample. The invitations for cervical screening were generally information poor and contained a median of only four out of 23 information items possible (17%), ranging from 0 to 12 (0-52%). The most important harms of cancer screening, overdiagnosis and overtreatment, were typically downplayed or unmentioned. The same applied to other important harms, such as falsepositive results and the psychological consequences from an abnormal test result. The majority of invitations took a paternalistic approach. While only two invitations (17%) included a pre-assigned appointment date, eight (70%) of the invitations contained strong appeals for participation. Conclusions: Invitations to cervical cancer screening were information poor and biased in favour of participation. This means that informed choice is not possible, which is in conflict with modern requirements for personal involvement in medical decisions.

How does information on the harms and benefits of cervical cancer screening alter the intention to be screened?: a randomized survey of Norwegian women

“…As women highly favored receiving expanded information and the source to be a qualified public health authority, invitation letters sent by the NCCSP could serve that purpose. A previous study found that Norwegian invitation letters included none of suggested information items on harms and benefits of CC screening and CC-related risks (Kolthoff et al, 2016). Our findings suggest that the provision of additional information on harms is unlikely to result in substantial reductions in screening participation and supports the proposition to expand the letters.…”

“…For the NCCSP, invitation letters may be an effective way of increasing participation (Camilloni et al, 2013;Everett et al, 2011), but must provide a balance between encouraging screening and ensuring that women make informed choices based on unbiased information about harms and benefits (Irwig et al, 2006). A study has found that invitation letters in 10 developed countries were biased in favor of participation by omitting important information on harms, for instance overdiagnosis and overtreatment (Kolthoff et al, 2016). Failing to provide such information reduces women's ability to make an informed choice (Kolthoff et al, 2016;Hersch et al, 2015).…”

“…A study has found that invitation letters in 10 developed countries were biased in favor of participation by omitting important information on harms, for instance overdiagnosis and overtreatment (Kolthoff et al, 2016). Failing to provide such information reduces women's ability to make an informed choice (Kolthoff et al, 2016;Hersch et al, 2015).…”

How is cervical cancer screening information communicated in UK websites? Cross-sectional analysis of content and quantitative presentation formats

“…We used an established checklist of information items about cervical screening,30 building on earlier evaluations of breast cancer screening communications 25 31 32. We assessed quantitative presentation formats considering the recommendations listed in table 1.…”

Effects of numerical information on intention to participate in cervical screening among women offered HPV vaccination: a randomised study

“…Most information material is non-numerical. [11] This may be justified, since previous research indicates that people can have difficulty deriving meaning from numerical risk communication. [12,13] However, we need to study how different types of information affect patients.…”