Intended for healthcare professionals


Communicating about screening

BMJ 2008; 337 doi: (Published 22 September 2008) Cite this as: BMJ 2008;337:a1591
  1. Vikki A Entwistle, professor1,
  2. Stacy M Carter, senior lecturer23,
  3. Lyndal Trevena, senior lecturer3,
  4. Kathy Flitcroft, research fellow4,
  5. Les Irwig, professor4,
  6. Kirsten McCaffery, senior research fellow4,
  7. Glenn Salkeld, professor4
  1. 1Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, DD1 4HJ
  2. 2Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, NSW 2006, Australia
  3. 3School of Public Health, University of Sydney
  4. 4Screening and Diagnostic Test Evaluation Program, School of Public Health, University of Sydney
  1. Correspondence to: V Entwistle v.a.entwistle{at}
  • Accepted 21 June 2008

Informed choice is important for screening, but not everyone wants or is able to analyse research data. Vikki Entwistle and colleagues propose a new approach to communication

People are offered a wide range of screening tests by diverse providers. For example: maternal and child health services screen for genetic conditions and developmental problems; general practitioners screen for cardiovascular risk factors; NHS programmes screen for bowel, breast, and cervical cancer; and commercial providers offer various health assessments, including body and gene scans. Provision of tests is not well regulated, and there is a bewildering amount of information of variable accuracy in the public domain.1

It is unclear how healthcare providers should communicate about screening in order to support appropriate uptake. And what constitutes appropriate uptake is also contested because of disagreements about the merits of particular tests and tensions between concerns to promote health and to respect autonomy.2 3 4 Debates about communication have tended to consider two types of approach, which we call “be screened’ and “analyse and choose.” We consider their problems and propose a third approach, “consider an offer.”

Be screened

The be screened approach aims to persuade people to have screening, usually with a view to promoting health gain, cost effective service provision, or profit.2 3 4 Its key features are encouragement to be screened; an emphasis on the benefits of screening and de-emphasis of potential harms; and a lack of recognition that it might be reasonable not to be screened.

This approach is found in commercial advertisements and some invitations to participate in government funded screening programmes. For example, the leaflet Breast Cancer: the Facts, from the NHS Breast Cancer Screening Programme presents screening as necessary for women aged over 50.5 It asks, “Should all women have breast screening?” and gives no hint of …

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