Assessment of changes to screening programmes: why randomisation is important

It is good to know that Bell et al [1] agree with me [2] that “an inclusive approach should be adopted for evaluating changes within screening programmes with involvement of non-health-professional members of the community.” [1] Their endorsement of deliberative democratic methods of assessing uncertainties, as well as the potential of their idea of randomising within population screening, by means of Citizens Deliberations, is another area where we are in agreement, and is heartening. [3]

But it is evident that I did not express myself clearly enough, since these areas of agreement do not cover my primary concern that they had not included (as far as I could determine) “… as yet any non-health-professional citizens in this preliminary proposal stage” [2] – i.e. in their discussions, either by reference to their having drawn on perhaps a local citizens` advisory group, or some-such, or by inclusion of a non-health professional in their deliberations for the work-up of this paper, or even also perhaps by inclusion in their authorship. It is a tenet of citizen and patient involvement that they should “be involved [with] from the start of deliberation” [2], i.e. the `back-of-an-envelope-stage`, if they want to get the very best out of full collaboration. It is also worth re-iterating, I believe, that “this proposal would provide a wonderful opportunity to educate the public whilst they are well about all the uncertainties that obtain in screening and in the research process generally.” [2]

The well-articulated author`s rapid response by Alexandra Barratt, [4] responding constructively to ideas and criticisms in the varied rapid responses to her paper about screening controversies, is a model for encouraging all-inclusive collaboration of anyone seeking to improve the current status quo. The public need to be brought up to speed by every available means, and given opportunity to contribute wherever and whenever possible. I think that you have missed providing a good opportunity at the outset of your work: `public involvement` could have beneficially helped to shape and inform your work.

[1] Authors` response to Thornton H. BMJ rapid response to Bell KJL, Bossuyt P, Glasziou P, Irwig L. Assessment of changes to screening programmes: why randomisation is important. BMJ 2015;350:h1566 http://www.bmj.com/content/350/bmj.h1566/rr-1

[2] Thornton H. BMJ rapid response to Bell KJL, Bossuyt P, Glasziou P, Irwig L. Assessment of changes to screening programmes: why randomisation is important. BMJ 2015;350:h1566 http://www.bmj.com/content/350/bmj.h1566/rr

[3] Rychetnik L, Carter SM, Abelson J, Thornton H, Barratt A, Entwistle VA, Mackenzie G, Salkeld G, Glasziou P. Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy. Journal of the National Cancer Institute. 2013.

[4] Barratt A. Author`s rapid response to previous responses to Barratt A, Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality
BMJ 2015;350:h867 http://www.bmj.com/content/350/bmj.h867/rr-8