Print information to inform decisions about mammography screening participation in 16 countries with population-based programs.
OBJECTIVE
To profile and compare the content and presentation of written communications related to informed decision-making about mammography.


METHODS
Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature.


RESULTS
A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures).


CONCLUSIONS
Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions.


CONCLUSIONS
Public health officials need to articulate their objectives and review written communication according to important decision-making domains.
Zapka
Jane G
JG
University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. jane.zapka@umassmed.edu
Geller
Berta M
BM
Bulliard
Jean-Luc
JL
Fracheboud
Jacques
J
Sancho-Garnier
Helene
H
Ballard-Barbash
Rachel
R
D001315:Australia; D001943:Breast Neoplasms / Q000175:diagnosis / Q000209:etiology; D002170:Canada; D018672:Community Health Planning; D003657:Decision Making; D003661:Decision Support Techniques; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent / Q000523:psychology* / Q000706:statistics & numerical data; D007557:Israel; D007564:Japan; D008327:Mammography / Q000009:adverse effects / Q000523:psychology* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000009:adverse effects / Q000523:psychology* / Q000706:statistics & numerical data; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration*; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D013664:Teaching Materials / Q000592:standards