Education And Debate

Controversies in Management: Psychological consequences are unclear

BMJ 1994; 309 doi: (Published 26 November 1994) Cite this as: BMJ 1994;309:1429
  1. Theresa Marteau, dierector
  1. aPsychology and Genetics Research Group, United Medical and Dental Schools of Guy's and St Thomas's, London SE1 9RT

    Advances in genetics enable testing for a growing number of conditions. But simply being able to do a test is not sufficient justification for introducing a screening programme. There are several criteria for deciding whether to start a screening programme, including severity of the condition, accuracy of the test, acceptability of the test and any consequent treatment, and cost.1 For population based screening programmes in which the intervention is the offer of termination of affected pregnancies, acceptability to patients is critically important. In addition, decisions about implementing a screening programme need to consider its contribution to a population's health needs.

    Acceptability of a screening programme can be assessed by both its uptake and its impact on individuals.

    How many people want screening?

    Assessing demand as opposed to health professionals' enthusiasm for a screening test is difficult, but crucial. Whether people accept the offer of carrier screening for cystic fibrosis depends in part on how it is offered. While over 70%, and in one study 95%, will have the test if it is offered immediately, only 25% will make a return visit for such a test.2 This raises the question of how strongly people want the test.3

    Among the few carrier couples who have been detected through population …

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