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J Med Ethics 2008;34:e5 doi:10.1136/jme.2008.024802
  • Clinical ethics
    • Electronic pages

Challenges of informed choice in organised screening

  1. W Østerlie1,
  2. M Solbjør1,
  3. J-A Skolbekken2,
  4. S Hofvind3,
  5. A R Sætnan4,
  6. S Forsmo1
  1. 1
    Department of Public Health and General Practice, Norwegian University of Science and Technology, MTFS, Trondheim, Norway
  2. 2
    Department of Psychology, Norwegian University of Science and Technology, Dragvoll, Trondheim, Norway
  3. 3
    The Cancer Registry of Norway, Oslo, Norway
  4. 4
    Department of Sociology and Political Science, Norwegian University of Science and Technology, Dragvoll, Trondheim, Norway
  1. Mrs W Østerlie, Department of Public Health and General Practice, Norwegian University of Science and Technology, MTFS, N-7489 Trondheim, Norway; wenche.osterlie{at}ntnu.no
  • Received 8 February 2008
  • Revised 14 May 2008
  • Accepted 30 May 2008

Abstract

Context: Despite much research on informed choice and the individuals’ autonomy in organised medical screening, little is known about the individuals’ decision-making process as expressed in their own words.

Objectives: To explore the decision-making process among women invited to a mammography screening programme.

Setting: Women living in the counties of Sør- and Nord-Trøndelag, Norway, invited to the first round of the Norwegian Breast Cancer Screening Program (NBCSP) in 2003.

Methods: Qualitative methods based on eight semistructured focus-group interviews with a total of 69 women aged 50–69 years.

Results: The decision to attend mammography screening was not based on the information in the invitation letter and leaflet provided by the NBCSP. They perceived the invitation letter with a prescheduled appointment as if a decision for mammography had already been made. This was experienced as an aid in overcoming the postponements that easily occur in daily lives. The invitation to mammography screening was embraced as an indication of a responsible welfare state, “like a mother taking care.”

Conclusion: In a welfare state where governmental institutions are trusted, mass screening for disease is acknowledged by screening participants as a valued expression of paternalism. Trust, gratitude, and convenience were more important factors than information about benefits, harms, and risks when the women made their decisions to attend screening. These elements should be included in the ethical debates on informed choice in preventive medicine.

Footnotes

  • Competing interests: None.

  • Funding: The research project was funded by The Research Council of Norway and the SINTEF Unimed Research Foundation.

  • Ethics approval: The study was approved by the Regional Committee on Medical Research Ethics.

  • Patient consent: Obtained.

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