title: Involving a Citizens' Jury in Decisions on Individual Screening for Prostate Cancer.
abstract: OBJECTIVE
  Most public health agencies and learned societies agree that the prostate-specific antigen (PSA) test in asymptomatic men should not be recommended, on account of its potential for harm. Yet PSA is still widely used as a screening test and is not being abandoned. This remains a significant public health issue, and citizens' engagement is needed. This study was designed to produce a deliberation on the PSA screening test by a citizens' jury.
  
  
  METHODS
  Fifteen citizens were selected and balanced for sex, age, and education. They received an information booklet and participated in a two-day meeting with experts to reach a deliberation on the question "Should the National Health Service discourage or recommend PSA as an individual screening test for prostate cancer in men 55-69 years old?". A facilitator ran the jurors' discussion.
  
  
  RESULTS
  All except three of the jurors decided that the National Health Service should discourage the use of PSA as an individual screening test for prostate cancer in 55-69 year-old men. The jury was particularly convinced by the uncertainty of the test outcomes, the utility of the test, and its cost/benefit ratio. Before the meeting 60% of jurors would have recommended the test to a relative, and all the male jurors would have done so. After the meeting these percentages fell to 15% and 12%.
  
  
  CONCLUSIONS
  This experience confirms the feasibility and effectiveness of delegating to a group of citizens the responsibility to decide on public health issues on behalf of the community. Public health authorities should invest in information campaigns aimed at the public and in educational initiatives for physicians. This also provided an opportunity to disseminate information on screening, over-diagnosis, and over-treatment.
authors.affiliation: Laboratory for medical research and consumer involvement, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mosconi
authors.affiliation: Laboratory for medical research and consumer involvement, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Colombo
authors.affiliation: Agenzia di Editoria Scientifica Zadig, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Satolli
authors.affiliation: Agenzia Nazionale per i servizi Sanitari regionali Agenas, Roma, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Carzaniga
mesh_terms: D000368:Aged; D003256:Community Participation / Q000523:psychology / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003657:Decision Making / Q000941:ethics; D055088:Early Detection of Cancer / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D011639:Public Opinion
chemical_list: D017430:Prostate-Specific Antigen