The information in the colorectal advice leaflet is not neutral and
we risk discrediting the screening process and us with it unless it is
changed. Screening advice leaflets should adhere to three principles: 1)
the leaflet should be written by independent advisors, not by committed
advocates of the intervention; 2) figures in the leaflet should be
presented in terms of natural frequencies or absolute risk reduction i.e.
figures that allow the patient to decide whether they (as opposed to the
population) will be screened; 3) mortality figures of the condition and
intervention should be put in the context of all cause mortality and in
the case of CRC, the lack of any effect on all cause mortality.
An advocacy system for writing advice leaflets could be the way
forward. Write two leaflets, one framing figures in such a way as to put
all but the most enthusiastic off screening; and write the second leaflet
in a way to promote uptake of screening. Let an independent "judge and
jury" decide which information is of most relevance to the patient and
write the booklet using these figures so the pros and cons both have their
say. The current CRC screening leaflet omits to mention figures for
absolute risk reduction and all cause mortality and is biased in favour of
promoting screening. Both Stekleberg [1] and our group [2] found that
honesty and providing extra information were unlikely to reduce the uptake
of screening but could prevent accusations of unfair pressure on
individuals to be screened. When patients are made ill, and sadly some
have been and will continue to be, and even die because of the screening
intervention, we must be assured that the information presented to them
does not put undue pressure on them to be screened. There are many medical
enthusiasts and pressure groups in favour of screening and rightly so, but
these are not the people to write advice booklets as we cannot presume the
patient shares their same enthusiasm.
1. Steckelberg A, Hulfenhaus C, Haastert B, Muhlhauser I. Effect of
evidence based risk information on "informed choice" in colorectal cancer
screening: randomised controlled trial. BMJ 2011; 342:d3193.
2. Patanwala IM, Brocklebank V, Inglis I, Trewby PN. A randomized
questionnaire-based study on the impact of providing numerical information
on colorectal cancer screening. J R Soc Med Sh Rep 2011;2:48. DOI
10.1258/shorts.2011.011030
Rapid Response:
An advocacy system for screening advice leaflets?
The information in the colorectal advice leaflet is not neutral and
we risk discrediting the screening process and us with it unless it is
changed. Screening advice leaflets should adhere to three principles: 1)
the leaflet should be written by independent advisors, not by committed
advocates of the intervention; 2) figures in the leaflet should be
presented in terms of natural frequencies or absolute risk reduction i.e.
figures that allow the patient to decide whether they (as opposed to the
population) will be screened; 3) mortality figures of the condition and
intervention should be put in the context of all cause mortality and in
the case of CRC, the lack of any effect on all cause mortality.
An advocacy system for writing advice leaflets could be the way
forward. Write two leaflets, one framing figures in such a way as to put
all but the most enthusiastic off screening; and write the second leaflet
in a way to promote uptake of screening. Let an independent "judge and
jury" decide which information is of most relevance to the patient and
write the booklet using these figures so the pros and cons both have their
say. The current CRC screening leaflet omits to mention figures for
absolute risk reduction and all cause mortality and is biased in favour of
promoting screening. Both Stekleberg [1] and our group [2] found that
honesty and providing extra information were unlikely to reduce the uptake
of screening but could prevent accusations of unfair pressure on
individuals to be screened. When patients are made ill, and sadly some
have been and will continue to be, and even die because of the screening
intervention, we must be assured that the information presented to them
does not put undue pressure on them to be screened. There are many medical
enthusiasts and pressure groups in favour of screening and rightly so, but
these are not the people to write advice booklets as we cannot presume the
patient shares their same enthusiasm.
1. Steckelberg A, Hulfenhaus C, Haastert B, Muhlhauser I. Effect of
evidence based risk information on "informed choice" in colorectal cancer
screening: randomised controlled trial. BMJ 2011; 342:d3193.
2. Patanwala IM, Brocklebank V, Inglis I, Trewby PN. A randomized
questionnaire-based study on the impact of providing numerical information
on colorectal cancer screening. J R Soc Med Sh Rep 2011;2:48. DOI
10.1258/shorts.2011.011030
Competing interests: No competing interests