Family Practice Vol. 20, No. 2, 222
© Oxford University Press 2003
Correspondence |
Informed consent for Screening
Department of General Pracice and Primary Care St George’s Hospital Medical School University of London Cranmer Terrace Tooting London SW17 ORE
Correspondence to Lynda Carter, 163 Trevelyan Road Tooting London SW17 9LP UK
Mauad et al. found that simple, understandable information was vital in successfully encouraging the uptake of cervical screening in a poor population in Brazil.1 We decided to assess British women’s understanding and opinions of two patient information leaflets about nuchal translucency scans and mammograms used at St George’s Hospital NHS Trust. In addition, we evaluated the leaflets in the light of General Medical Council (GMC) guidelines on informed consent for screening.2 These stipulate that the possible outcomes of a screening test and the likelihood of a positive or negative finding must be understood for consent to be informed; and that the patient should be made aware of the potential benefits and harms of the test and of the availability of counselling and support services.
We designed a questionnaire, consisting of seven questions for each leaflet, which reflected the GMC guidelines on informed consent for screening. In March 2001, 20 women aged 23–50 years, who had never been exposed to either form of screening, were given the patient information leaflets to read for as long as they needed, followed by the questionnaire.
The proportion of participants obtaining 
5/7 correct answers was 90% (18/20) for the nuchal translucency scan leaflet but only 55% (11/20) for the mammography leaflet. Although participants obtained more correct information from the nuchal translucency scan leaflet and this complied better with the GMC guidelines, all comments about the leaflet were negative. However, the majority of respondents commented positively on the mammography leaflet which was perceived to be more accessible and understandable. Comments on the leaflets identified areas not covered by GMC guidance that were important to the participants, including layout, format and language of the leaflet, practical information about the test and whether the respondents felt reassured by the leaflet.
The findings of variation in accessibility and content of leaflets are in line with previous studies of written information used to obtain informed consent for screening procedures.3,4 Coulter has stated that the information in patient information leaflets should conform to scientific accuracy and be presented in a way that is acceptable and useful to the patient.5 Our results suggest that attention to design, format and general tone is valued highly by women considering screening procedures, although information that is perceived as being poorly communicated, as in the nuchal translucency screening leaflet, does not appear to detract from patients obtaining accurate information. Information that reflects the GMC guidelines results in greater understanding but may not be as well liked by women considering screening procedures. We agree with Mauad and colleagues that easy to understand information is likely to increase the uptake of screening. GPs should therefore try to ensure that information given to obtain informed consent for screening, such as that for routine cervical smears, both reflects the GMC guidelines and is presented in an accessible format.
References
1 Mauad E, Gomes UA, Mogueira JL, Melani AGF, Lemos DL, Hidalgo GS. Prevention of cervical cancer in a poor population in Brazil. Fam Pract 2002; 19: 189–192.
2 General Medical Council. Seeking Patients’ Consent: The Ethical Considerations. London: General Medical Council, 1999.
3 Slaytor EK, Ward JE. How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets. Br Med J 1998; 317: 264–264.
4 Baille C, Hewison J. Obtaining selective consent for scanning, rather than screening is possible. Br Med J 1999; 318: 805.
5 Coulter A. Evidence based patient information. Br Med J 1998; 317: 225–226.
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