To screen or not to screen: What factors influence complex screening decisions?

Contrary to people's intuitions, many screenings can have both benefits (e.g., lives saved) and harms (e.g., unnecessary treatments). Statistical information is often provided to ensure informed decision making. However, few theoretical models have addressed the role of comprehension of such information in screening decisions. In an experiment, we studied how cognitive skills, emotions, and a priori beliefs about screening affect comprehension of the evidence of benefits and harms from screening and intentions to get screened. Young adults (N = 347) received information about a disease for which a screening test was available and numerical information about the benefits and harms from screening. Results showed that comprehension and perceptions of benefits are central to decisions; however, lay perceptions of harms along the screening cascade require further study. Numeracy, science literacy, and emotions can promote informed decision making by facilitating comprehension of the evidence. At the same time emotions and beliefs resulting from persuasive campaigns can have strong effects on screening intentions beyond the available evidence. To apply to screening procedures where informed decision making is recommended, theoretical models of screening decisions need to include comprehension of benefits and harms, and account for how cognitive skills, emotions, and beliefs influence comprehension and decisions. (PsycINFO Database Record