Intended for healthcare professionals

Letters Decision aids and screening

Information v promotion

BMJ 2010; 341 doi: (Published 23 November 2010) Cite this as: BMJ 2010;341:c6650
  1. Ben Hudson, senior lecturer1
  1. 1Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand
  1. ben.hudson{at}

Bekker expresses concern that “uncritical acceptance of informed choice initiatives may cause more harm than good.”1 She notes that in a study of decision aids for bowel cancer screening a smaller proportion of patients given a decision aid accepted screening than did those given the usual promotional leaflet.2 She suggests it may be better to pursue a policy of “informed uptake rather than informed decision making.”

Screening reduces bowel cancer mortality by around one death per 1000 people screened over 10 years, with no demonstrated effect on all cause mortality.3 People deciding whether to take part in screening must balance this small potential benefit against the potential harms (false positives, risks of colonoscopy, overdiagnosis, and false negatives). This decision requires access to clear accurate information about the screening programme, and a decision aid is one way to provide this. The value of such an aid should be assessed by its ability to provide this information not, as this editorial suggests, by its ability to increase participation. If we uphold people’s right to make informed decisions about their healthcare we must accept that some decisions will not coincide with what we think is best. To suggest otherwise implies a return to a more paternalistic age.


Cite this as: BMJ 2010;341:c6650


  • Competing interests: None declared.


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