Deliberate democracy for cancer screening decisions: the effect of a community jury on men's knowledge and intentions to participate in PSA screening
Thomas, R, Glasziou, P, Rychetnik, L, Mackenzie, G, Gardiner, R & Doust, J 2014, 'Deliberate democracy for cancer screening decisions: the effect of a community jury on men's knowledge and intentions to participate in PSA screening', paper presented to Preventing overdiagnosis: winding back the harms of too much medicine, University of Oxford, UK, 15-17 September.
Because of uncertainty about benefits and the risk of "overdiagnosis", PSA screening is controversial in the medical community. It is also unclear whether men would choose to participate if "fully informed". A community jury (informed by experts, with participants able to ask questions and deliberate on the information) enables public consideration of complex information. Aims: To determine whether participating in a community jury, compared with a control group, had an effect on men's knowledge about and their intention to participate in PSA screening.
We randomized twenty-six men aged 50 to 70 years to either a 2-day community jury or control group. The control group were given two factsheets about PSA screening from the Australian Cancer Council and Andrology Australia). Three experts presented information on PSA screening to the community jury group: a neutral expert provided back ground information; an expert emphasized the benefits of screening with a focus on selected screening; and another emphasized the harms, then participants discussed the information and questioned the experts
At post-assessment, men in the community jury group had less intention to screen for prostate cancer than men in the control group (Effect Size -0.6SD; p=.049). After adjusting for the number of prior PSA tests, community jury men had a lower mean score for intention to be screened for prostate cancer than control group men (p=.005).The difference in the intention to be screened for prostate cancer was sustained at 3 month follow-up. Community jury men also believed they were more informed about PSA screening (Effect Size=1.2SD; p=0.001) and answered more knowledge questions correctly.
Community juries may be a valuable method for exploring the value placed on screening benefits versus overdiagnosis and a method for eliciting target group informed input to clinical guidelines but requires further research in community jury formats and recruitment