Deliberative democracy and cancer screening. The use of citizens' s juries in health policy decision-making

Abstract

Background: Participants in breast cancer screening programmes may benefit from early detection but may also be exposed to the risks of overdiagnosis and false positives. It is argued that citizens's juries offer important insights into how democratic deliberation could be institutionalised in contemporary political decision making processes. The aim of this deliberative democracy study was to know if Andalucia's Public Health System should offer screening mammography for women aged 50 and 69 years. We selected a citizens's jury to evaluate the reasons for their decision and to know the recommendations for politicians. Methods: Thirteen women aged 50 and 69 years, who regularly participate in the breast cancer screening programme, agreed to participate as a jury to deliberate of the harms and benefits of this controversial topic. The participants were assembled on three consecutive days. On the first day a neutral expert trained the jury to understand the exposures during the second day of two expert witnesses positioned in favor of and against screening mammography, respectively. The third the jury deliberated, extracted its conclusions, cast its vote and exposed its recommendations for politicians. Transcription of the text and the qualitative analysis of the information was done with the support of the ATLAS. ti software. Results: We observed an improvement in the knowledge using analysis quantitative design. The Citizen's Jury voted 11-2. Eleven women voted yes and two did not. Women thanks for it, but there are still ignorance and confusion about breast cancer screening. There are three reasons for voting yes, for their health, for the nature of the test and for their individual freedom. There are women who argue the lack of effectiveness and the cost to justify their negative vote to mammography, at least with a universal character. Women make proposals to policymakers related to improving information, psychological care and research. Conclusions: Spanish women have a very positive attitude to breast cancer screening although the information transmitted changes the opinion of some women, who want an informed decision making. They bet to maintain or increase themedicalization of their lives.