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Laberge M, Brundisini FK, Zomahoun HTV, Sawadogo J, Massougbodji J, Gogovor A, David G, Légaré F. Knowledge exchange sessions on primary health care research findings in public libraries: A qualitative study with citizens in Quebec. PLoS One 2023; 18:e0289153. [PMID: 37490456 PMCID: PMC10368291 DOI: 10.1371/journal.pone.0289153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Little is known about knowledge transfer with the public. We explored how citizens, physicians, and communication specialists understand knowledge transfer in public spaces such as libraries. The initial study aimed at evaluating the scaling up of a program on disseminating research findings on potentially inappropriate medication. Twenty-two citizen workshops were offered by 16 physicians and facilitated by 6 communication specialists to 322 citizens in libraries during spring 2019. We did secondary analysis using the recorded workshop discussions to explore the type of knowledge participants used. Participants described four kinds of knowledge: biomedical, sociocultural beliefs, value-based reasoning, and institutional knowledge. Biomedical knowledge included scientific evidence, research methods, clinical guidelines, and access to research outcomes. Participants discussed beliefs in scientific progress, innovative clinical practices, and doctors' behaviours. Participants discussed values related to reliability, transparency, respect for patient autonomy and participation in decision-making. All categories of participants used these four kinds of knowledge. However, their descriptions varied particularly for biomedical knowledge which was described by physician-speakers and communication specialists-facilitators as scientific evidence, epidemiological and clinical practice guidelines, and pathophysiological theories. Communication specialists-facilitators also described scientific journalistic sources and scientific journalistic reports as proxies of scientific evidence. Citizens described biomedical knowledge in terms of knowledge to make informed decisions. These findings offer insights for future scientific knowledge exchange interventions with the public.
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Affiliation(s)
- Maude Laberge
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
| | - Francesca Katherine Brundisini
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Jasmine Sawadogo
- First Nations of Quebec and Labrador Health and Social Services Commission, Quebec, Canada
| | - José Massougbodji
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Amédé Gogovor
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
| | - Geneviève David
- Centre d'excellence sur le Partenariat avec les Patients et le Public, Centre de Recherche du CHUM, Québec, Canada
- École Nationale d'administration Publique, Québec, Canada
| | - France Légaré
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
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Hofmann B. To Consent or Not to Consent to Screening, That Is the Question. Healthcare (Basel) 2023; 11:healthcare11070982. [PMID: 37046909 PMCID: PMC10094591 DOI: 10.3390/healthcare11070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
The objective of this article is to address the controversial question of whether consent is relevant for persons invited to participate in screening programs. To do so, it starts by presenting a case where the provided information historically has not been sufficient for obtaining valid informed consent for screening. Then, the article investigates some of the most relevant biases that cast doubt on the potential for satisfying standard criteria for informed consent. This may indicate that both in theory and in practice, it can be difficult to obtain valid consent for screening programs. Such an inference is profoundly worrisome, as invitees to screening programs are healthy individuals most suited to make autonomous decisions. Thus, if consent is not relevant for screening, it may not be relevant for a wide range of other health services. As such, the lack of valid consent in screening raises the question of the relevance of one of the basic ethical principles in healthcare (respect for autonomy), one of the most prominent legal norms in health legislation (informed consent), and one of the most basic tenets of liberal democracies (individual autonomy). Thus, there are good reasons to provide open, transparent, and balanced information and minimize biases in order to ascertain informed consent in screening.
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Carter SM. Why Does Cancer Screening Persist Despite the Potential to Harm? SCIENCE TECHNOLOGY AND SOCIETY 2021. [DOI: 10.1177/0971721820960252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Population screening for early-stage cancer or cancer precursors began in the mid-twentieth century, with the goal of reducing suffering from cancer illness and lengthening average life by preventing cancer deaths. Since the establishment of cancer screening, concerns have emerged that it may be doing considerable harm; despite this, screening practices have remained relatively intractable. This intractability in the face of harm is the central problematic of my analysis. I reinterpret a large study of breast, cervical and prostate cancer screening completed recently by our Australian research group, working across empirical bioethics, public health and social science. I suggest three reasons why cancer screening might persist as it does, and thus reach conclusions about what might be required to make cancer screening systems more responsive to the potential for harm.
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Affiliation(s)
- Stacy M. Carter
- Stacy M. Carter (corresponding author), Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Building 29, Room 318, University of Wollongong, Northfields Avenue, NSW 2522 Australia
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Wang Z, Bero L, Grundy Q. Understanding professional stakeholders' active resistance to guideline implementation: The case of Canadian breast screening guidelines. Soc Sci Med 2020; 269:113586. [PMID: 33333377 DOI: 10.1016/j.socscimed.2020.113586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/04/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022]
Abstract
Health guidelines aim to improve patient outcomes through the promotion of evidence-based practice. Yet, when a guideline's recommendations significantly differ from, or threaten the interests, values and preferred practices of end-users, organised and often very public resistance to guideline implementation may result. To explore this phenomenon, we theorise a case study consisting of the public discourse following the update to a primary care breast screening guideline in Canada in 2018. Informed by sociological perspectives on the professions and evidence-based medicine, this paper aims to explore: [1] why professional stakeholders form active resistances to the implementation of some clinical guidelines; and, [2] how professional values, perspectives, interests and/or experiences influence the stakeholders' stance. Current understandings have taken a reductive approach in conceptualising the exclusion of experts and their resistance as "conflict of interest." Rather, we suggest that resistance is the product of multiple areas of contention, stemming from tensions related to clinical and professional autonomy, medical jurisdiction, and the role of medical elites. We highlight considerations for future guideline development and implementation process changes to mitigate and resolve issues related to active resistance. These considerations include understanding resistance as a political strategy, increasing transparency of public input and coalition building as a part of the public response to active resistance.
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Affiliation(s)
- Zhicheng Wang
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia.
| | - Lisa Bero
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia; University of Colorado School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, USA.
| | - Quinn Grundy
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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Seaman K, Dzidic PL, Castell E, Saunders C, Breen LJ. Subject positions in screening mammography and implications for informed choice. Psychol Health 2020; 36:478-495. [PMID: 32404016 DOI: 10.1080/08870446.2020.1766043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Screening mammography has potential benefits as well as harms, but these are not always communicated to women. We therefore explored how women discuss screening mammography, the subject positions made available in their discourse, and the implications of these for informed choice. Design: We conducted 16 individual interviews with women aged 44-72 years who were attenders (n = 11) and non-attenders (n = 5) of screening, and analysed transcripts through Foucauldian Discourse Analysis. Main Outcome Measures: A semi-structured interview guide, informed by literature and researcher expertise, was used to collect data. Results: The women constructed screening mammography as either helpful or potentially harmful. We identified three subject positions-The Responsible Woman (who attends screening), The Irresponsible Woman (who does not attend screening), and the Judicious Woman (who engages in alternate breast health practices). Conclusion: These subject positions have the potential to limit women's choices, constrain shared decision-making with health professionals, and restrict women's engagement in risk-reducing behaviours. An expanded range of options ultimately offers an alternate future in which women's autonomy to control their own bodies is better supported.
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Affiliation(s)
- Kristen Seaman
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Peta L Dzidic
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Emily Castell
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Christobel Saunders
- School of Medicine, Division of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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Valuing Healthcare Improvement: Implicit Norms, Explicit Normativity, and Human Agency. HEALTH CARE ANALYSIS 2018; 26:189-205. [PMID: 29058204 DOI: 10.1007/s10728-017-0350-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
I argue that greater attention to human agency and normativity in both researching and practicing service improvement may be one strategy for enhancing improvement science, illustrating with examples from cancer screening. Improvement science tends to deliberately avoid explicit normativity, for paradigmatically coherent reasons. But there are good reasons to consider including explicit normativity in thinking about improvement. Values and moral judgements are central to social life, so an adequate account of social life must include these elements. And improvement itself is unavoidably normative: it assumes that things could and should be better than they are. I seek to show that normativity will always be implicated in the creation of evidence, the design of programs, the practice of healthcare, and in citizens' judgements about that care, and to make a case that engaging with this normativity is worthwhile.
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Labrie NHM, Ludolph R, Schulz PJ. Investigating young women's motivations to engage in early mammography screening in Switzerland: results of a cross-sectional study. BMC Cancer 2017; 17:209. [PMID: 28327090 PMCID: PMC5361801 DOI: 10.1186/s12885-017-3180-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/08/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The scientific and public debate concerning organized mammography screening is unprecedentedly strong. With research evidence concerning its efficacy being ambiguous, the recommendations pertaining to the age-thresholds for program inclusion vary between - and even within - countries. Data shows that young women who are not yet eligible for systematic screening, have opportunistic mammograms relatively often and, moreover, want to be included in organized programs. Yet, to date, little is known about the precise motivations underlying young women's desire and intentions to go for, not medically indicated, mammographic screening. METHODS A cross-sectional online survey was carried out among women aged 30-49 years (n = 918) from Switzerland. RESULTS The findings show that high fear (β = .08, p ≤ .05), perceived susceptibility (β = .10, p ≤ .05), and ego-involvement (β = .34, p ≤ .001) are the main predictors of screening intentions among women who are not yet eligible for the systematic program. Also, geographical location (Swiss-French group: β = .15, p ≤ .001; Swiss-Italian group: β = .26, p ≤ .001) and age (β = .11, p ≤ .001) play a role. In turn, breast cancer knowledge, risk perceptions, and educational status do not have a significant impact. CONCLUSIONS Young women seem to differ inherently from those who are already eligible for systematic screening in terms of the factors underlying their intentions to engage in mammographic screening. Thus, when striving to promote adherence to systematic screening guidelines - whether based on unequivocal scientific evidence or policy decisions - and to allow women to make evidence-based, informed decisions about mammography, differential strategies are needed to reach different age-groups.
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Affiliation(s)
- Nanon H. M. Labrie
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
| | - Ramona Ludolph
- Institute of Communication & Health, Faculty of Communication Sciences, Università della Svizzera italiana, USI, Via G. Buffi 13, CH-6904 Lugano, Switzerland
| | - Peter J. Schulz
- Institute of Communication & Health, Faculty of Communication Sciences, Università della Svizzera italiana, USI, Via G. Buffi 13, CH-6904 Lugano, Switzerland
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Parker L. Including values in evidence-based policy making for breast screening: An empirically grounded tool to assist expert decision makers. Health Policy 2017; 121:793-799. [PMID: 28571666 DOI: 10.1016/j.healthpol.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/12/2017] [Accepted: 03/01/2017] [Indexed: 11/19/2022]
Abstract
Values are an important part of evidence-based decision making for health policy: they guide the type of evidence that is collected, how it is interpreted, and how important the conclusions are considered to be. Experts in breast screening (including clinicians, researchers, consumer advocates and senior administrators) hold differing values in relation to what is important in breast screening policy and practice, and committees may find it difficult to incorporate the complexity and variety of values into policy decisions. The decision making tool provided here is intended to assist with this process. The tool is modified from more general frameworks that are intended to assist with ethical decision making in public health, and informed by data drawn from previous empirical studies on values amongst Australian breast screening experts. It provides a structured format for breast screening committees to consider and discuss the values of themselves and others, suggests relevant topics for further inquiry and highlights areas of need for future research into the values of the public. It enables committees to publicly explain and justify their decisions with reference to values, improving transparency and accountability. It is intended to act alongside practices that seek to accommodate the values of individual women in the informed decision making process for personal decision making about participation in breast screening.
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Affiliation(s)
- Lisa Parker
- Centre for Values, Ethics and the Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, NSW 2006, Australia.
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Ghanouni A, Renzi C, Meisel SF, Waller J. Common methods of measuring 'informed choice' in screening participation: Challenges and future directions. Prev Med Rep 2016; 4:601-607. [PMID: 27843761 PMCID: PMC5107638 DOI: 10.1016/j.pmedr.2016.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/09/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
There is general agreement among public health practitioners, academics, and policymakers that people offered health screening tests should be able to make informed choices about whether to accept. Robust measures are necessary in order to gauge the extent to which informed choice is achieved in practice and whether efforts to improve it have succeeded. This review aims to add to the literature on how to improve methods of measuring informed choice. We discuss and critique commonly-used approaches and outline possible alternative methods that might address the issues identified. We explore the challenges of defining what information should be provided about screening and hence understood by service users, appraise the use of 'thresholds' to define e.g. positive attitudes towards screening, and describe problems inherent in conceptualising 'informed choice' as a single dichotomous outcome that either does or does not occur. Suggestions for future research include providing greater detail on why particular aspects of screening information were considered important, analysing knowledge and attitude measures at an ordinal or continuous level (avoiding problematic decisions about dichotomising data in order to set thresholds), and reconceptualising informed choice as a multifactorial set of outcomes, rather than a unitary one.
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Affiliation(s)
| | | | | | - Jo Waller
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, United Kingdom
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Williams J, Carter S, Rychetnik L. Contested Guideline Development in Australia’s Cervical Screening Program: Values Drive Different Views of the Purpose and Implementation of Organized Screening: Table 1. Public Health Ethics 2016. [DOI: 10.1093/phe/phw030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Parker LM, Carter SM. The Role of Socially Embedded Concepts in Breast Cancer Screening: An Empirical Study with Australian Experts. Public Health Ethics 2016. [DOI: 10.1093/phe/phw012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Parker LM, Rychetnik L, Carter SM. The role of communication in breast cancer screening: a qualitative study with Australian experts. BMC Cancer 2015; 15:741. [PMID: 26480942 PMCID: PMC4617891 DOI: 10.1186/s12885-015-1749-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts' opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? METHODS We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. RESULTS Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers' breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here's why; Screening is available please consider whether it's right for you. There was a similar level of support for all three approaches. Experts' reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. CONCLUSIONS There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims.
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Affiliation(s)
- Lisa M Parker
- Centre for Values, Ethics and the Law in Medicine (VELiM), Sydney School of Public Health, The University of Sydney, Medical Foundation Building, K 25 (92-94 Parramatta Road), Sydney, NSW, 2006, Australia.
| | - Lucie Rychetnik
- School of Medicine Sydney, The University of Notre Dame (Australia), 160 Oxford St, Darlinghurst, NSW, 2010, Australia.
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine (VELiM), Sydney School of Public Health, The University of Sydney, Medical Foundation Building, K 25 (92-94 Parramatta Road), Sydney, NSW, 2006, Australia.
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