Article Figures & Tables
Tables
Deliberation Panel size Location Population (2016) (17) OBSP screening rate, %* Recruitment strategy used Brochures reviewed by small group† Previous panel Print advertisement Online advertisement Online survey panel A 13 Ontario 13 488 494 43.2 X X British Columbia, Newfoundland and Labrador
Alberta, Saskatchewan
B 12 Northern Ontario 107 909 48.7 X X Manitoba, Quebec
Alberta, Quebec
C 12 Southern Ontario 97 496 59.3 X X Alberta, Nova Scotia, Northwest Territories
British Columbia, Saskatchewan, Yukon Territory
D 12 Greater Toronto Area 2 731 571 34.9 X Manitoba, Newfoundland and Labrador, Northwest Territories
Quebec, Nova Scotia, Yukon Territory
Characteristic Deliberation; no. (%) of participants A B C D Total Demographic characteristics Age, yr ≤ 39 1 0 0 0 1 (2) 40–49 1 0 0 0 1 (2) 50–59 5 9 8 7 29 (59) 60–69 4 3 4 4 15 (31) ≥ 70 2 0 0 1 3 (6) Highest level of education completed No schooling 0 1 0 0 1 (2) Elementary school 0 1 0 0 1 (2) High school 2 2 2 0 6 (12) Completed some postsecondary 0 0 0 4 4 (8) College 3 2 6 2 13 (26) Bachelor’s degree 3 5 3 5 16 (33) Postgraduate training or professional degree 4 1 1 1 7 (14) No response 1 0 0 0 1 (2) Income, $ < 20 000 1 1 1 0 3 (6) 20 000–39 999 0 2 1 1 4 (8) 40 000–59 999 0 1 2 2 5 (10) 60 000–79 999 2 3 5 1 11 (22) 80 000–99 999 1 1 0 3 5 (10) ≥ 100 000 7 0 2 3 12 (24) Prefer not to answer 2 4 1 2 9 (18) Experience with cancer Personal history of cancer other than breast cancer 2 1 1 2 6 (12) History of breast cancer in close family member 2 4 8 5 19 (39) Never had mammography (n = 44)* 0 2 1 2 5 (11) ↵* Women only.
- Table 3:
Core principles that should guide the development of future screening materials, with illustrative comments by participants*
Principle Illustrative quote Accurate and evidence-based “The best way you protect your health is by getting a mammogram every 2 years.” The best way to protect my health? Well, there’s lots of ways to protect my health, and they have nothing to do with getting mammograms. So that may be a big statement to make; it’s not entirely true. (PB3)
Because [screening organizations] have that credibility, I think … the onus should be on them to be more balanced. (PA10)
I think that if [the evidence is] not in the pamphlets, then it hurts the credibility of the organization. (PA4)Comprehensive I have to read this and think “This is what I want to do.” Not “Hmm, maybe I need to research more.” It should give me everything I need as a good starting point to make a decision. (PB4)
You see here, and they are all guilty of the same darn thing — are mammograms safe? Do they hurt? All they do is talk to the actual mammogram … not about risk, ever, really, anywhere. (PA2)
It’s almost like it needs an index at the front that has the categories of information that are in there. So, if all you’re looking for is how should I prepare for my appointment, you go to page 5. If it’s what should I be expecting from my doctor, it’s a little bit of a table of contents, almost, that would guide you through it. Because I think there’s a lot of good information in here, but I agree with you, [the chance of] anybody who would actually sit down and read through the whole thing is probably fairly minimal. But it’s like “Well, there’s the one thing that I’m wondering about that I would like to find.” (PD3)Choice Just enough [information] to make that informed decision and choice, that’s what I value. Informed choice. Educated decisions. (PB1)
I think the only other thing … [is] sort of asking the question when you get the letter of how to decide if breast cancer screening is right for you. So it’s some considerations, like even a hint, at there are some things that you should think about. How to decide if it’s right for you. And maybe it’s 4 or 5 provocative questions that you should be asking yourself. (PD3)
Don’t sell me on the mammography, give me the information so I can make a choice. (PA5)Accessible The font is clearly not for the 50–74 age group, and I find that so annoying because look at who is trying to read this. And we hate getting our reading glasses out. (PC5) Consistent When I go to a McDonald’s or [Tim Horton’s], I want my coffee to be the same right across Canada. So when I go for medical treatment — and that’s more important to me than my coffee — I want to be able to get the same information if I live in Ontario or [if] my child goes to the east coast for school and stays there, I want to know that she’s getting the same [information] as I am. (PC6)
This should be a national discussion, it doesn’t really matter where we live, we’re all going to be affected the same way. (PD11)Transparent This idea of treating as many people as possible — that’s totally in conflict with the idea of supporting people in making a choice and a decision, because the [earlier] part is saying that we’re going to keep pushing people, regardless … our goal is to get as many people as possible through screening, if they decide it’s appropriate for them or not. (PD8)
This one that does the risks and the benefits is nice because I think I tend to believe [it] more. If they give you the benefits and they give you the risks, too, it’s almost giving it more credibility because they are telling you what the risks or the cons are as well. So, to me, this gives this more credibility. (PB4)↵* Participants are identified by deliberation (A, B, C or D) and participant number (e.g., A1).
Area of focus Suggestion Formatting Use of bold or highlighting (colour) to attract the reader’s eye is helpful for key points
Font size must be large enough to be easily read; consider your primary audience (e.g., women > 50 yr) when determining the formatting of the materials
Use colour to catch the reader’s eye — something needs to draw them in, so the materials don’t seem too technical or “dull”
Do not provide too much information on 1 page; if including information on both sides of a page (e.g., a letter), be certain that the reader knows to turn the page over
Cover needs to grab the attention of the reader
Statistics Present statistics for all issues, even if there is uncertainty in the data (e.g., for overdiagnosis)
Provide comparisons (e.g., mortality rates for screened and unscreened women) to put information into context
Present the information in different ways to ensure understanding (e.g., numbers, charts, graphs, infographics)
Present the statistics as number in 100 or 1000 as those are the easiest numbers to relate to
Images Use images sparingly
Images can be used to get key information across (e.g., photographs of a mammography machine)
Avoid photographs of people, where possible, so all citizens can see themselves in the photographs
When including photographs of people, ensure that the diversity of the population is captured and that the photographs represent the target audience (women aged 50–74 yr)
Structure of information Use headings, table of contents to make information easy to find
Consider a questions-and-answer approach throughout the materials, or a frequently asked questions section
Providing information in a series of short points (bullet form) can help the reader get through a large amount of information
Language Consider carefully what language to use when describing risks and benefits (e.g., pros and cons, harms and benefits)
Ensure that the language supports choice
Be aware of the reading level of the text
Source Consider other sources of information in addition to print materials: social media, websites, email campaign, in-person campaigns, television
Trusted media personalities (e.g., daytime talk show hosts) for the age group could also be engaged to share the evidence
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