Making policy decisions about population screening for breast cancer: the role of citizens' deliberation.
OBJECTIVE
To test a method of assessing whether a community of interest - when well informed - would be prepared to support or reject a public policy decision about cancer screening. In particular, whether the New Zealand government should offer free mammography screening to all women aged 40-49 years.


METHODS
Eleven women aged from 40 to 49 years, randomly selected from the electoral roll, agreed to participate in trial of a citizens' jury: a deliberative method of gathering the views of the public. Only selected aspects of the jury method were trialled. Participants met over a day and a half to hear evidence from expert witnesses with differing views and to deliberate the verdict.


RESULTS
All but one woman changed their minds during the jury process, and voted against government provision of mammography screening in this age group. The main reasons reported were the inaccuracy of the test and the potential for harm, and the lack of firm evidence of saving lives in this age group.


CONCLUSIONS
A deliberative 'citizens' jury' approach is a feasible way of eliciting a well informed, considered community view about screening or other population health initiatives. Pro-screening views of affected populations may change when individuals are given accurate information and enabled to deliberate about benefits and harms. This method could be used to determine how complex benefits and harms are weighed by affected populations, particularly where experts and advocacy groups disagree.
Paul
Charlotte
C
Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand. charlotte.paul@otago.ac.nz
Nicholls
Rachel
R
Priest
Patricia
P
McGee
Rob
R
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000523:psychology; D003256:Community Participation / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000523:psychology; D008403:Mass Screening / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009520:New Zealand; D011050:Policy Making; D011639:Public Opinion