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Table 2 Comparison of main rationales provided for recommendations for and against screening

From: Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force

Condition Recommendation(s) in favor of screening Rationale for recommending screening Recommendation(s) against screening Rationale for recommending against screening
Alcohol misuse USPSTF 2013 • Recognized lack of direct evidence from randomized controlled trials of screening interventions • Reported adequate evidence for screening test accuracy and behavioral interventions to reduce alcohol misuse • Indicated that harms likely small to none UKNSC 2011 • Emphasized limited overall evidence and no evidence of improved health outcomes from randomized controlled trials of screening programs
Depression USPSTF 2016 (Adults) • Reported that there was adequate evidence that programs that combined screening and support improved clinical outcomes • Reported adequate evidence for screening test accuracy and depression treatments • Indicated that there was adequate evidence that harms of screening are small to none CTFPHC 2013 (Adults) • Emphasized lack of evidence from randomized controlled trials of screening programs • Specifically indicated that the systematic review for the USPSTF guidelines conflated screening and treatment • Raised concern about harms of potentially high rate of false positive screens, about the applicability of treatment evidence to screened patients, and about resource implications in absence of evidence of benefit
USPSTF 2016 (Adolescents) • Recognized lack of direct evidence from randomized controlled trials of screening interventions • Reported adequate evidence for screening test accuracy and depression treatments • Indicated that screening is unlikely to be associated with significant harms and harms would be small for pharmacological treatments if properly monitored UKNSC 2011 (Postnatal women) • Emphasized lack of evidence from randomized controlled trials of improved maternal or infant outcomes from depression screening • Noted lack of evidence of cost-effectiveness
UKNSC 2015 (Adults) • Emphasized lack of evidence from randomized controlled trials of improved health outcomes • Raised concern about harms due to false positive screens and overtreatment and about cost-effectiveness
Domestic or intimate partner violence USPSTF 2013 (Adult women) • Recognized lack of direct evidence from randomized controlled trials of screening interventions • Reported adequate evidence for screening test accuracy and interventions to reduce harms from violence • Indicated that harms “no greater than small” UKNSC 2006 (Pregnant women) • No report available
UKNSC 2013 (Adult women) • Emphasized lack of evidence of improved health outcomes from randomized controlled trials of screening programs