Cochrane decision aids for people facing health treatment or screening decisions

This reference is a good one. Don’t be scared by all the stats – just scroll down to the plain English version if you can’t face grappling with them.

I now have a name for at least part of what I have been suffering from. No, not breast cancer, but: “decisional conflict related to being uninformed.”

(Sorry about the capitals, something has gone wrong with the formatting and I can’t find how to correct it).

Even stars explode

Updated review published today on The Cochrane Library: Decision aids for people facing health treatment or screening decisions

http://bit.ly/LhRFop

Citation: Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2014 , Issue 1 . Art. No.: CD001431. DOI: 10.1002/14651858.CD001431.pub4

Now 115 included studies, nearly 35,000 participants, showing decision aids improve people’s knowledge, help them feel more informed, participate more in decision making.

The Summary includes, ‘ Decision aids reduce the choice of prostate specific antigen (psa) testing and elective surgery when patients consider other options’.

My comment: the harms and lack of benefit of breast cancer screening have brought about calls for a fresh look at cost and effectiveness.

It seems to me that men with raised psa levels are…

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Mindset and the Memory Box

As we get closer to moving house, I have been doing some sorting out. Today I retrieved a box of memorabilia from the garage. My life started to flash before my eyes —

There’s a note from a parishioner congratulating my Dad on my birth in Spring 1959. He approved of the “good English names” I had been given.

There’s a big chronological gap (little early childhood stuff in this box, except for a few photos which made it onto a montage done – I think – for my 40th birthday).

Then there’s the religious novel, written in turquoise ink when I was thirteen. One draft only. What confidence! And a short story which the mother of a friend of mine (an editor I think) got quite excited about.

There are the school reports. When I think of the tracking and monitoring that goes on now, they seem superficial and skeletal. No one had heard of formative assessment. I don’t think my teachers had any imposed targets to meet, and nor did I. I wonder if my learning was any the worse for that?

There are a few essays from my sixth form years. There’s my university dissertation (you know, the one about TS Eliot – see my post from September,”Raid on the Inarticulate”). And the one from my PGCE year on children’s reading (easier to write, I remember). Today I didn’t dare read any of this writing, though, because I am so sure it would compare unfavourably with what my daughters produce now, at a similar age and stage. So what’s that about then?

A lot of my husband’s work is based around Mindset Theory. The wisdom goes that you can develop more of a “growth” (as distinct from a “fixed”) mindset – that is, learn to welcome and work with mistakes, take risks, and choose challenges, not safety, in your learning. You see yourself as being able to develop. Your skills and abilities aren’t fixed.

I don’t know if anybody has thought about how your mindset affects the way you view your past. The Eliot dissertation got a 2:2 (with no feedback comments at all – unbelievable), and the PGCE one got very favourable feedback (no formal marks given at all – equally unbelievable). None of my sixth form essays ever got lower than an A-. That must mean that there’s a chance they’re at least OK. But the fact that I even need to look at the marks suggests to me that I’m still looking for external validation. And I’m still so convinced they’re c*** that I can’t open the folders. So the question is, why am I so hard on my former self? Does it matter if my writing was bad, all that time ago? If it was, can I not celebrate my progress since, rather than beat myself up?

There’s going to be at least one more post about this Memory Box. I was going to take it and store it in the new house (at the back of the big new cupboard). But there’s more — I think I need to keep it out for a bit.

Maybe by the next time I post, I will have had the courage to do some reading. Watch this blog.

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Screening inquiry launched, plus ‘Breast Cancer Screening – what we still don’t know’ – H.G. Welch

More on overdiagnosis and overtreatment. The link to the article by Welch is worth following for an American perspective. I am getting to know the names of the key people in the overdiagnosis field, and have been in touch with many of them. I will be writing to the Commons Select Committee.

Even stars explode

On 17 December 2013, MPs launched an inquiry into the scientific merits of national health screening programmes and whether calls for health screening to be extended to cover conditions such as prostate cancer, lung cancer and post-natal depression are based on solid science.

Chair of the Science and Technology Committee Andrew Miller MP stated:
“The NHS spends a significant amount of money on health screening and it is important that this is underpinned by good scientific evidence.
Thousands of women are screened for breast cancer every year and lives are saved as a result but there may also be women who undergo unnecessary treatment and surgery as a result of screening. Calls to extend screening to other conditions should ensure that there is good evidence that the screening would be effective.
We will be examining the evidence base behind the decisions on which illnesses to screen for and will be…

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