Intended for healthcare professionals


Citizens’ juries can bring public voices on overdiagnosis into policy making

BMJ 2019; 364 doi: (Published 30 January 2019) Cite this as: BMJ 2019;364:l351


Using citizen science to boost healthcare improvement research

  1. Chris Degeling, senior fellow1,
  2. Rae Thomas, associate professor2,
  3. Lucie Rychetnik, adjunct professor3
  1. 1Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Australia
  2. 2Centre for Research in Evidence Based Practice, Bond University, Australia
  3. 3School of Medicine Sydney, University of Notre Dame, Australia
  4. Correspondence to: C Degeling

As practitioners and policy makers struggle to manage the risks and harms of overdiagnosis, Chris Degeling and colleagues contend that citizens’ juries offer a way forward

Key messages

  • Overdiagnosis challenges the social contract that underpins healthcare, and community voices are often missing from the relevant policy discussions

  • Citizens’ juries elicit the voices, values, and preferences of informed citizens who are presented with evidence based expert views

  • Jurors deliberate the evidence among themselves before formulating their opinions and recommendations

  • Citizens’ juries can elucidate public values that can then be used to inform policies and practices to manage the risks of overdiagnosis

  • The findings can contribute to guideline development and proposed changes to disease thresholds

  • The process of citizens’ juries align with the basic tenets of evidence based medicine and can broaden and improve the dialogue around medical uncertainty

Unnecessary and harmful interventions from overdiagnosis challenge the social and ethical contract that underpins healthcare.12 Strategies to tackle overdiagnosis from population screening should engage with the public and consider its values and concerns.3 Most high income countries develop evidence based policies to guide population screening using stringent criteria that are applied by expert panels to review the available technical evidence. Similarly, if perhaps not so systematically, expert panels collect and analyse pathophysiological and clinical evidence to determine disease thresholds and definitions.4 But in both cases the final judgments on the acceptability and legitimacy of different screening policies and disease definitions are informed by the values of the decision makers, because the relative balance of harms and benefits of making changes are also subjectively weighed and valued.567 For the deliberation sponsors (researchers, government, or other agencies), putting matters to the public can promote greater social and political engagement, public accountability, and confidence in the decision ultimately made.

Public engagement …

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