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Informed choice and screening organisation

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Patients are more likely to make an informed choice to accept a screening test if it is arranged as part of a routine hospital visit rather than if it requires a separate visit. As the rate of informed choice is influenced both by the information provided and the manner in which testing is organised, it is essential to discover the method of organisation that leads to the highest rate of informed choice. Two general hospitals were compared, each applying a different method of organisation for maternal serum screening for Down's Syndrome. One hospital offered the test as an extension of the routine blood taking visit whilst the other arranged for a separate visit to take place especially for the test.

A questionnaire that measured knowledge of the test and attitudes towards it was returned on time by 84% of the 2313 eligible women. The results were measured against eventual uptake and showed that the proportion of women making an informed choice to accept the test was higher at the routine visit hospital than the separate visit hospital (41% v 21%). A similar proportion at both hospitals (23%) made an informed choice to decline the test.

Whether choice is informed or not is more important in some screening programmes than the level of uptake - particularly in prenatal programmes where the potential outcome can lead to invasive tests or termination. The authors therefore recommend that a randomised trial is undertaken to determine whether or not the causal findings from this descriptive study stand up to critical appraisal.