Institute of Health Policy, Management and Evaluation (Dobrow, Sullivan, Rabeneck), Dalla Lana School of Public Health, University of Toronto; Cancer Care Ontario (Hagens, Rabeneck), Toronto, Ont.; Memorial University of Newfoundland (Chafe), St. John's, NL; Department of Medicine (Rabeneck), University of Toronto, Toronto, Ont.
CMAJ. 2018 Apr 9;190(14):E422-E429. doi: 10.1503/cmaj.171154.
In 1968, Wilson and Jungner published 10 principles of screening that often represent the de facto starting point for screening decisions today; 50 years on, are these principles still the right ones? Our objectives were to review published work that presents principles for population-based screening decisions since Wilson and Jungner's seminal publication, and to conduct a Delphi consensus process to assess the review results.
We conducted a systematic review and modified Delphi consensus process. We searched multiple databases for articles published in English in 1968 or later that were intended to guide population-based screening decisions, described development and modification of principles, and presented principles as a set or list. Identified sets were compared for basic characteristics (e.g., number, categorization), a citation analysis was conducted, and principles were iteratively synthesized and consolidated into categories to assess evolution. Participants in the consensus process assessed the level of agreement with the importance and interpretability of the consolidated screening principles.
We identified 41 sets and 367 unique principles. Each unique principle was coded to 12 consolidated decision principles that were further categorized as disease/condition, test/intervention or program/system principles. Program or system issues were the focus of 3 of Wilson and Jungner's 10 principles, but comprised almost half of all unique principles identified in the review. The 12 consolidated principles were assessed through 2 rounds of the consensus process, leading to specific refinements to improve their relevance and interpretability. No gaps or missing principles were identified.
Wilson and Jungner's principles are remarkably enduring, but increasingly reflect a truncated version of contemporary thinking on screening that does not fully capture subsequent focus on program or system principles. Ultimately, this review and consensus process provides a comprehensive and iterative modernization of guidance to inform population-based screening decisions.
1968 年，Wilson 和 Jungner 提出了 10 项筛检原则，这些原则通常被视为当今筛检决策的事实上的起点；如今 50 年过去了，这些原则是否仍然正确？我们的目标是回顾自 Wilson 和 Jungner 开创性出版物以来发表的有关基于人群的筛检决策的原则，并进行 Delphi 共识过程以评估审查结果。
我们进行了系统评价和改良 Delphi 共识过程。我们在多个数据库中搜索了 1968 年或之后以指导基于人群的筛检决策为目的的英文发表文章，描述了原则的制定和修改，并将原则作为一组或列表呈现。比较了确定的原则集的基本特征（例如数量、分类），进行了引文分析，并对原则进行了迭代综合和整合，以评估其演变。共识过程的参与者评估了对综合筛检原则的重要性和可解释性的认同程度。
我们确定了 41 组和 367 条独特的原则。每条独特的原则都被编码为 12 项综合决策原则，这些原则进一步分为疾病/状况、检验/干预或方案/系统原则。方案或系统问题是 Wilson 和 Jungner 的 10 项原则中的 3 项的重点，但在审查中确定的所有独特原则中，占近一半。这 12 项综合原则经过两轮共识过程的评估，导致对其相关性和可解释性进行了具体的改进。没有发现遗漏或缺失的原则。
Wilson 和 Jungner 的原则具有很强的持久性，但越来越多地反映出当代筛检思维的一种简化版本，没有充分捕捉到后来对方案或系统原则的关注。最终，本审查和共识过程提供了对基于人群的筛检决策的全面和迭代现代化指导。
