Geraldine Mackenzie

Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy

Cancer screening is widely practiced and participation is promoted by various social, technical, and commercial drivers, but there are growing concerns about the emerging harms, risks, and costs of cancer screening. Deliberative democracy methods engage citizens in dialogue on substantial and complex problems: especially when evidence and values are important and people need time to understand and consider the relevant issues. Information derived from such deliberations can provide important guidance to cancer screening policies: citizens values are made explicit, revealing what really matters to people and why. Policy makers can see what informed, rather than uninformed, citizens would decide on the provision of services and information on cancer screening. Caveats can be elicited to guide changes to existing policies and practices. Policies that take account of citizens opinions through a deliberative democracy process can be considered more legitimate, justifiable, and feasible than those that dont.

Sentencing and public confidence: results from a national Australian survey on public opinions towards sentencing

This paper examines the critical issue of public confidence in sentencing, and presents findings from Phase I of an Australia-wide sentencing and public confidence project. Phase I comprised a nationally representative telephone survey of 6005 participants. The majority of respondents expressed high levels of punitiveness and were dissatisfied with sentences imposed by the courts. Despite this, many were strongly supportive of the use of alternatives to imprisonment for a range of offences. These nuanced views raise questions regarding the efficacy of gauging public opinion using opinion poll style questions; indeed the expected outcome from this first phase of the four phase sentencing and public confidence project. The following phases of this project, reported on elsewhere, examined the effects of various interventions on the robustness and nature of these views initially expressed in a standard ‘top of the head’ opinion poll.

A community jury on PSA screening: What do well-informed men want the government to do about prostate cancer screening - A qualitative analysis

Objective Cancer screening policies and programmes should take account of public values and concerns. This study sought to determine the priorities, values and concerns of men who were ‘fully informed’ about the benefits and harms of prostate-specific antigen (PSA) screening; and empirically examine the value of a community jury in eliciting public values on PSA screening. Setting Community jury was convened on the Gold Coast, Queensland (Australia) to consider PSA screening benefits and harms, and whether government campaigns on PSA screening should be conducted. Participants 27 men (volunteers) aged 50–70 with no personal history of prostate cancer and willing to attend jury 6–7 April 2013: 12 were randomly allocated to jury (11 attended). Outcome measures A qualitative analysis was conducted of the jury deliberations (audio-recorded and transcribed) to elicit the jurys views and recommendations. A survey determined the impact of the jury process on participants’ individual testing decisions compared with control group. Results The jury concluded governments should not invest in programmes focused on PSA screening directed at the public because the PSA test did not offer sufficient reassurance or benefit and could raise unnecessary alarm. It recommended an alternative programme to support general practitioners to provide patients with better quality and more consistent information about PSA screening. After the jury, participants were less likely to be tested in the future compared with the controls, but around half said they would still consider doing so. Conclusions The jurys unanimous verdict about government programmes was notable in the light of their divergent views on whether or not they would be screened themselves in the future. Community juries provide valuable insights into the priorities and concerns of men weighing up the benefits and harms of PSA screening. It will be important to assess the degree to which the findings are generalisable to other settings.

A matter of judgement: The effect of information and deliberation on public attitudes to punishment

The idea of reducing public punitiveness through providing information and encouraging deliberation has attracted considerable interest. However, there remains no solid evidence of durable changes in attitude. The study presented here provides a test of the hypothesis that information combined with deliberation can affect general measures of punitiveness, confidence in the courts and acceptance of alternatives to imprisonment (the three dependent variables). The study involved a pre-test, post-test experimental design. Participants were randomly allocated to either an intervention group or a control condition. Statistically significant changes in the dependent variables were observed immediately following the intervention but these changes were not sustained when measured at follow-up nine months later. Further, at the time of the follow-up the differences between the control group scores and the intervention group scores were not significantly different. The observed changes immediately following the intervention are seen to be a function of the changed relationship of the respondent to the task. The implications of the results for integrating public perspectives into policy are discussed. It is argued that rather than a focus on public education, a more productive direction is to focus on the way the public is engaged on matters concerning punishment.

Deliberative democracy and cancer screening consent: a randomised control trial of the effect of a community jury on men's knowledge about and intentions to participate in PSA screening

Objective Prostate-specific antigen (PSA) screening is controversial. A community jury allows presentation of complex information and may clarify how participants view screening after being well-informed. We examined whether participating in a community jury had an effect on mens knowledge about and their intention to participate in PSA screening. Design Random allocation to either a 2-day community jury or a control group, with preassessment, postassessment and 3-month follow-up assessment. Setting Participants from the Gold Coast (Australia) recruited via radio, newspaper and community meetings. Participants Twenty-six men aged 50–70u2005years with no previous diagnosis of prostate cancer. Intervention The control group (n=14) received factsheets on PSA screening. Community jury participants (n=12) received the same factsheets and further information about screening for prostate cancer. In addition, three experts presented information on PSA screening: a neutral scientific advisor provided background information, one expert emphasised the potential benefits of screening and another expert emphasised the potential harms. Participants discussed information, asked questions to the experts and deliberated on personal and policy decisions. Main outcome and measures Our primary outcome was change in individual intention to have a PSA screening test. We also assessed knowledge about screening for prostate cancer. Results Analyses were conducted using intention-to-treat. Immediately after the jury, the community jury group had less intention-to-screen for prostate cancer than men in the control group (effect size=−0.6 SD, p=0.05). This was sustained at 3-month follow-up. Community jury men also correctly identified PSA test accuracy and considered themselves more informed (effect size=1.2 SD, p<0.001). Conclusions Evidence-informed deliberation of the harms and benefits of PSA screening effects mens individual choice to be screened for prostate cancer. Community juries may be a valid method for eliciting target group input to policy decisions. Trial registration number Australian and New Zealand Clinical Trials Registry (ACTRN12612001079831).

Bargaining in the shadow of the law - using utility functions to support legal negotiation

Most dispute resolution is settled by negotiation rather than litigation. However, such bargaining often occurs in the shadow of the law. To help support interest-based negotiation, we explore the use of utility functions to support negotiation analysis. We discuss in detail a utility function we have developed in the area of family-law mediation. This function is currently being used as the basis of an online dispute resolution system.

Public preferences for sentencing purposes: What difference does offender age, criminal history and offence type make?

Preferences of 800 randomly selected Australians for retributive and utilitarian sentencing purposes were examined in response to brief crime scenarios where offender age, offence type and offender history were systematically varied. Respondents selected rehabilitation as the most important purpose for first-time, young and burglary offenders. Punishment was endorsed as most important for repeat, adult and serious assault offenders. Multinomial logistic regression analysis revealed that offence history was a stronger predictor of public preferences than offender age or offence type; the odds of choosing rehabilitation compared with punishment were significantly increased by a factor of 6.1 for cases involving first-time offenders. It appears that when given specific cases to consider, the public takes an approach akin to that taken by the sentencing courts as they weigh up the importance of the various purposes for the case at hand. Public preferences are thus broadly consistent with current law and sentencing practice.

Sentencing and public confidence in Australia: the dynamics and foci of small group deliberations

This study is the first of its kind in Australia to use the deliberative small group methodology to explore participants’ deeper, nuanced thoughts on specific criminal justice issues in order to gain insight into the underlying beliefs that influence people’s opinions on sentencing. The use of small group discussions allows an analysis of the dynamics of people’s interactions and the potential of these to elicit deeper, more thoughtful deliberation. Participants’ comments around two policy areas – mandatory sentencing and the use of alternatives to imprisonment – were founded on concerns about the need for judges to tailor the sentence to fit the specific circumstances of each case. The methodology itself has shown that people may change their initial opinions on complex issues when given the opportunity to discuss and reflect on their beliefs.

The importance of mandatory data breach notification to identity crime

The relationship between data breaches and identity crime has been scarcely explored in current literature. However, there is an important relationship between the misuse of personal identification information and identity crime as the former is in many respects the catalyst for the latter. Data breaches are one of the ways in which this personal identification information is obtained by identity criminals, and thereby any response to data breaches is likely to impact the incidence of identity crime. Initiatives around data breach notification have become increasingly prevalent and are now seen in many State legislatures in the United States and overseas. The Australian Government is currently in the process of introducing mandatory data breach notification laws. This paper explores the introduction of mandatory data breach notification in Australia, and lessons learned from the experience in the US, particularly noting the link between data breaches and identity crime. The paper proposes that through the introduction of such laws, identity crimes are likely to be reduced.

The significance of mandatory data breach warnings to identity crime

The relationship between data breaches and identity crime has been scarcely explored in current literature. However, there is an important relationship between the misuse of personal identification information and identity crime as the former is in many respects the catalyst for the latter. Data breaches are one of the ways in which this personal identification information is obtained by identity criminals, and thereby any response to data breaches is likely to impact the incidence of identity crime. Initiatives around data breach notification have become increasingly prevalent and are now seen in many State legislatures in the United States and overseas. The Australian Government is currently in the process of introducing mandatory data breach notification laws. This paper explores the introduction of mandatory data breach notification in Australia, and lessons learned from the experience in the US, particularly noting the link between data breaches and identity crime. The paper proposes that through the introduction of such laws, identity crimes are likely to be reduced. Keywords—identity crime; data breaches; mandatory breach reporting; privacy