Challenges of informed choice in organised screening.

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.

Reduced use of diagnostic obstetric ultrasound in Norway. Result of consensus panel recommending routine screening in pregnancy?

PURPOSE: To investigate the practice of obstetric ultrasound in Norway before and 2 years after a consensus conference recommending routine screening. Material, method: Two national representative materials sampled with a 2-year interval are compared. RESULTS: The average number of examinations was reduced from 2.46 to 2.2 (p = 0.014). Obstetrical institutions practising screening examined their patient less frequently than non-screening institutions (2.10 vs. 2.75 times, p less than 0.001 whereas in 1986 the converse was the case. CONCLUSIONS: Screening has become more widespread, and a more rational practice has developed.

Look to Norway! (But not uncritically).

The authors of the paper argue that Norway's national health service, despite public perceptions, is both inexpensive and technologically advanced. Norway has a highly regulated medical system at both the national and local levels, and many distribution issues take the form of political debate. As a result, the authors believe that medical care and equipment is equitably distributed, but perhaps over-densely, throughout the country. Although the overall picture is optimistic, there is some concern that technologies, health care priorities, and decision-making processes should be more carefully examined by consensus conferences, advisory groups, and experts in technology assessment.