22 Decision AIDS for organized cancer screening in germany

Objectives Germany has organized programs for breast, colorectal and cervical cancer screening. The target audience receives regular letters that are accompanied by a decision aid. Besides general information about the screening programmes, the decision aids include description of the advantages and disadvantages of screening to support informed choice. The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned to produce the cover letters and the decision aids. The development process and the user testing results will be presented. Method The decision aids were developed in accordance with the International Patient Decision Aid Standards (IPDAS). A systematic search and evidence assessment were performed to analyse the benefits and risks of screening. The decision aids were tested in focus groups and surveys. The process also included a public commenting procedure. Results Most users perceived the decision aids to be informative, helpful and balanced. The majority found the information on harms of screening relevant, including overdiagnosis and overtreatment. Healthcare professionals were more reluctant to provide information on harms in the decision aids, fearing it might lead to lower participation in screening. The surveys showed that the decision aid only had little impact on screening intention. The majority would participate in the screening programmes, despite the possible harms. The results of user testing concerning acceptance of the decision aids and screening intention were quite similar across the different decision aids. Larger differences occurred for example in the acceptance of certain graphical formats. Conclusions Decision aids are a useful tool to support informed choice in an organized screening programme. They were well accepted by most users. There is further need for research on the implementation of the decision aids.