Interventions to enhance informed choices among invitees of screening programmes-a systematic review.
BACKGROUND
Informed decision making about participation has become an explicit purpose in invitations for screening programmes in western countries. An informed choice is commonly defined as based on: (i) adequate levels of knowledge of the screening and (ii) agreement between the invitee's values towards own screening participation and actual (intention to) participation.


METHODS
We systematically reviewed published studies that empirically evaluated the effects of interventions aiming at enhancing informed decision making in screening programmes targeted at the general population. We focused on prenatal screening and neonatal screening for diseases of the foetus/new-born and screening for breast cancer, cervical cancer and colorectal cancer. The Medline, EMBASE and Cochrane databases were searched for studies published till April 2012, using the terms 'informed choice', 'decision making' and 'mass screening' separately and in combination and terms referring to the specific screening programmes.


RESULTS
Of the 2238 titles identified, 15 studies were included, which evaluated decision aids (DAs), information leaflets, film, video, counselling and a specific screening visit for informed decision making in prenatal screening, breast and colorectal cancer screening. Most of the included studies evaluated DAs and showed improved knowledge and informed decision making. Due to the limited number of studies the results could not be synthesized.


CONCLUSIONS
The empirical evidence regarding interventions to improve informed decision making in screening is limited. It is unknown which strategies to enhance informed decision making are most effective, although DAs are promising. Systematic development of interventions to enhance informed choices in screening deserves priority, especially in disadvantaged groups.
1 Department of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands h.vanagt@erasmusmc.nl.
Heleen M E
HM
van Agt
1 Department of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands.
Ida J
IJ
Korfage
2 Department of Public Health, Academic Medical Center / University of Amsterdam, the Netherlands.
Marie-Louise
ML
Essink-Bot
D000328:Adult; D000368:Aged; D002755:Choice Behavior; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015997:Neonatal Screening / Q000379:methods; D009369:Neoplasms / Q000175:diagnosis*; D010358:Patient Participation / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data