ideasIdea
A mandatory decision aid before any multi-cancer blood test
People are told a blood test can find fifty cancers, but not how many false alarms or how much is unknown. A short, tested decision aid before the test would make consent real.
Consumer marketing of MCEDs precedes trial evidence. Propose a standardised, regulator-approved decision aid quantifying false positives, unresolved positives, overdiagnosis uncertainty, and the absence of mortality evidence, with an RCT of its effect on informed choice and uptake.
Hypothesis
The decision aid improves knowledge scores by at least 20 points and reduces uptake among low-risk individuals without reducing uptake among high-risk individuals.
Rationale
Decision aids improve knowledge and reduce overuse in PSA screening; MCEDs carry greater uncertainty.
What would test it
Run a 2,000-person RCT in a screening-age population.
Maturity
speculative
Who has to act
regulator
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
- Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.
- Misinformation and unproven therapies · Patients are sold unproven treatments and frightened away from proven ones.