Task:
We were asked to consider the way roles and identities for patients change, how uncertainty is managed. We were asked to consider the aspects of moral obligations and vested interests in screening, and medical screening elsewhere in the world. Additional questions included whether screening for risk change what it means to be a patient? And whether clinical diagnosis may now include 'being at risk', and what this could mean for clinicians providing treatment and care?
Definition:
The UK national screening committee defines screening as "The process of identifying apparently healthy people who may be at increased risk of a disease or condition". Other definitions from our group varied from assessing asymptomatic people for the presence of a disease, to identifying people at risk of developing a disease.
Topics discussed included PKU, cancer (lung, prostate, breast, GI), diabetes, hypertension, prenatal problems and STIs.
Who it benefits:
The impact of personal experience of an illness was raised as being a factor for becoming an advocate of a screening programme. The same experience (or knowledge of a family history) may motivate individuals to attend for screening as a patient. Many people profit financially from the presence of screening programmes. There are certainly statistics to show the reduction in mortality from various causes that result from effective screening programmes
Who it harms:
Some screening programmes can be seen as inefficient use of money. There can be a great deal of distress caused to individuals: ‘After a screening result for PKU confirmation of diagnosis (by a geneticist) can be as long as six months. Parents might treat their child as being sick and live in uncertainty for quite a long time. Rothenberg et Sills (1968) report that some parents even suffered from an “PKU anxiety syndrome” after a false positive test.’
People can become ‘patients’ unnecessarily. Distress can be caused by further investigation and treatment on the back of a false positive screening result. There may be premature disease status labelling.
There were several discussions around the anxiety associated with screening programmes. A level of anxiety is required to motivate people to attend a programme but this can go too far. Also, people can be seen as morally deficient if they do not attend a programme.
The different experiences for the rich and poor in Nigeria was discussed, stemming from a private health system. Although screening is seen as being ‘behind’ where we are in this country, it was mentioned that the introduction of UK type screening program could place poor people in a more difficult positions, since they may not have money to investigate positive screening results.
Conclusion:
There were many comments about what constitutes an ‘acceptable’ screening test (along the lines of the Wilson-Jungner criteria): ‘For screening to be introduced, we need a test that is simple, quick, not too expensive and not harmful’ and a positive screening test ‘should be followed up with a quick diagnostic test to reduce uncertainty’
