A SYSTEMATIC REVIEW AND CONSOLIDATION OF DECISION PRINCIPLES FOR SCREENING

Purpose: To identify published work that present principles for guiding population-based screening decisions, synthesize and compare them to Wilson and Jungner’s 1968 seminal ‘principles and practice of screening for disease’, and produce a consolidated list of decision principles for screening.  

Method: A systematic approach to reviewing relevant English language literature published since 1968 was taken.  Multiple databases, including Medline, Embase, CINAHL, Web of Science, Google Scholar and Google Book, were searched.  Inclusion criteria required that articles: (1) were published in English, (2) were published in 1968 or later, (3) described the development of key principles, criteria, questions or frameworks for screening, (4) that were presented as a set or clear list, and (5) that were intended to provide guidance on making population-based screening decisions.  Identified sets of decision principles were analysed in three ways.  First, identified sets were compared in terms of their basic characteristics (e.g., number, categorical focus and format).  Second, a citation analysis was conducted to document formal linkages and cross-citations.  Third, all individual principles were combined into a master list and iteratively synthesised/consolidated into separate thematic categories.  

Result: Thirty-six sets of decision principles were identified. They varied widely in terms of the number of individual principles, focus and format.  These 36 sets represented 312 unique principles which were synthesized and allocated into 12 consolidated decision principles for screening that were aligned with three categories: (1) disease/condition, (2) test/intervention and (3) program/system principles.  Program/system issues were the focus of only three of Wilson and Jungner’s ten principles, but six of our 12 consolidated principles and almost half of all unique decision principles identified in our review (154 of 312).  

Conclusion: While the Wilson and Jungner principles have been widely cited, a number of subsequent modifications and new formulations have been proposed over the ensuing decades. Our findings document a shift in these principles from focusing on the disease/condition and test/intervention to program/system principles. This shift requires consideration of a broader and more diverse evidence base, which necessitates inclusion and translation of different sets of knowledge, expertise and perspectives. Based on our review, we have developed a consolidated list of 12 decision principles for screening which incorporate greater focus on program/system principles and represents a contemporary resource for those tasked with making population-based screening decisions.