Parker Lisa M, Rychetnik Lucie, Carter Stacy M
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.
School of Medicine Sydney, The University of Notre Dame (Australia), 160 Oxford St, Darlinghurst, NSW, 2010, Australia.
BMC Cancer. 2015 Oct 19;15:741. doi: 10.1186/s12885-015-1749-0.
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?
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.
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.
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.
优化乳腺钼靶乳腺癌筛查结果的一个广为接受的策略是改善与女性关于筛查的沟通。然而，沟通预期要达成什么目标，以及为何如此或如何达成，往往并不明确。我们调查了澳大利亚专家对乳腺筛查沟通的看法。我们的研究问题是：1. 澳大利亚专家对于与消费者就乳腺筛查进行沟通有哪些看法？2. 专家如何思考这个话题？
我们采用了定性研究方法，采访了澳大利亚33位在澳大利亚乳腺钼靶乳腺癌筛查领域有显著影响力的乳腺筛查专家。我们运用目的抽样和理论抽样，从不同专业角色（包括临床医生、项目管理人员、政策制定者、倡导者和研究人员）中识别出对乳腺筛查沟通有一系列观点的专家。
专家们通过关注两个主要问题来讨论与消费者沟通的话题：在多大程度上引导消费者进行乳腺癌筛查选择，以及就过度诊断传达什么信息。每位专家根据他们对这些话题的看法，采用了三种消费者沟通方式之一。我们将这些方式标记为：接受筛查；接受筛查及原因；提供筛查服务，请考虑是否适合您。对这三种方式的支持程度相近。专家们的推理基于他们对潜在价值观的理解和优先级排序，包括：带来益处、避免伤害、带来的益处多于伤害、尊重自主性和透明度。
专家们在与乳腺筛查消费者的沟通问题上存在分歧。我们的研究为这种持续存在的缺乏共识提供了一些见解，突出了专家赋予价值观的不同含义以及价值观优先级排序的不同方式。我们建议，关于伦理价值观的明确讨论可能有助于集中思考、澄清概念并促进在与消费者沟通的政策方面达成共识。更具体地说，我们建议考虑筛查沟通政策的决策者应首先确定并就优先考虑的具体价值观达成一致，并以此指导他们确定沟通目标以及哪种沟通策略将实现这些目标。
