Do invitations for cervical screening provide sufficient information to enable informed choice? A cross-sectional study of invitations for publicly funded cervical screening.
OBJECTIVE
To investigate whether invitations for publicly funded cervical screening provide sufficient information to enable an informed choice about participation.


METHODS
Cross-sectional study using a checklist of 23 information items on benefits and harms from cervical screening and the risks related to cervical cancer.


METHODS
Invitations to publicly funded cervical screening in 10 Scandinavian and English-speaking countries.


METHODS
Ten Scandinavian and English speaking countries.


METHODS
Sixteen screening units representing 10 Scandinavian and English speaking countries.


METHODS
Number of information items presented in invitations for cervical screening.


RESULTS
We contacted 21 coordinating units from 11 countries and 20 (95%) responded. Of these, four units did not issue invitations, but the remaining 16 coordinating units in 10 different countries supplied a sample. The invitations for cervical screening were generally information poor and contained a median of only four out of 23 information items possible (17%), ranging from 0 to 12 (0-52%). The most important harms of cancer screening, overdiagnosis and overtreatment, were typically downplayed or unmentioned. The same applied to other important harms, such as false-positive results and the psychological consequences from an abnormal test result. The majority of invitations took a paternalistic approach. While only two invitations (17%) included a pre-assigned appointment date, eight (70%) of the invitations contained strong appeals for participation.


CONCLUSIONS
Invitations to cervical cancer screening were information poor and biased in favour of participation. This means that informed choice is not possible, which is in conflict with modern requirements for personal involvement in medical decisions.
Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen 1014, Denmark sie-kolthoff@hotmail.com.
Sie Karen
SK
Kolthoff
Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen 1014, Denmark.
Mie Sara
MS
Hestbech
The Nordic Cochrane Centre, Copenhagen 2100, Denmark.
Karsten Juhl
KJ
Jørgensen
Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen 1014, Denmark Primary Health Care Research Unit, Zealand Region, Denmark.
John
J
Brodersen
D044362:Australasia; D002170:Canada; D054626:Consumer Health Information / Q000379:methods / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003657:Decision Making; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods / Q000523:psychology / Q000592:standards; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D010358:Patient Participation / Q000523:psychology; D018570:Risk Assessment; D012537:Scandinavian and Nordic Countries; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control
communication; ethics; public health