Using a Deliberative Poll on breast cancer screening to assess and improve the decision quality of laypeople

Abstract

Balancing the benefits and harms of mammography screening is difficult and involves a value judgement. Screening is both a medical and a social intervention, therefore public opinion could be considered when deciding if mammography screening programmes should be implemented and continued. Opinion polls have revealed high levels of public enthusiasm for cancer screening, however, the public tends to overestimate the benefits and underestimate the harms. In the search for better public decision on mammography screening, this study investigated the quality of public opinion arising from a Deliberative Poll. In a Deliberative Poll a representative group of people is brought together to deliberate with each other and with experts based on specific information. Before, during and after the process, the participants’ opinions are assessed. In our Deliberative Poll a representative sample of the Danish population aged between 18 and 70 participated. They studied an online video and took part in five hours of intense online deliberation. We used survey data at four timepoints during the study, from recruitment to one month after the poll, to estimate the quality of decisions by the following outcomes: 1) Knowledge; 2) Ability to form opinions; 3) Opinion stability, and 4) Opinion consistency. The proportion of participants with a high level of knowledge increased from 1% at recruitment to 56% after receiving video information. More people formed an opinion regarding the effectiveness of the screening programme (12%), the economy of the programme (27%), and the ethical dilemmas of screening (10%) due to the process of information and deliberation. For 11 out of 14 opinion items, the within-item correlations between the first two inquiry time points were smaller than the correlations between later timepoints. This indicates increased opinion stability. The correlations between three pairs of opinion items deemed theoretically related a priori all increased, indicating increased opinion consistency. Overall, the combined process of online information and deliberation increased opinion quality about mammography screening by increasing knowledge and the ability to form stable and consistent opinions.

Fictitious cases as a methodology to discuss sensitive health topics in focus groups

“…Generally, lay people are increasingly becoming more informed of medical terms, conditions, and treatments, which improves comprehension of the potential benefits and harms of screening. However, research has found that information about the different types of harms can be difficult for individuals to relate to their own decision about screening (Jensen et al, 2021 ). Lay people oppositely express great enthusiasm for cancer screening (Degeling et al, 2018 ; Scherer et al, 2019 ; Schwartz et al, 2004 ; Waller et al, 2015 ), and when making the decision to participate in screening, people might not evaluate the benefits and the harms equally (Festinger, 1957 ; Hodson, 2020 ).…”

Questioning ‘Informed Choice’ in Medical Screening: The Role of Neoliberal Rhetoric, Culture, and Social Context

“…In an interview study about continuing mammography screening above the recommended age limit, the women reject the risk of harm by self-exempting themselves from the risk of being harmed or downplaying their reaction to or the importance of the harm [26]. In a deliberative poll study, the women do not only disregard information discordant with their previous beliefs but alter their preferences for mammography screening to fit the information available [27].…”