230 Chapter 7 Patient/public information Guidelines can be used to inform shared decision making. Patient versions of guidelines, which translate recommendations into simple language, are commonly used to inform patients and the public about information in guidelines that is important to them. While the development of guidelines follows strict criteria, there is a heterogeneous methodology for developing patient versions [31, 32]. Patient decision aids are additional tools derived from guidelines. These are intended to assist patients in making an informed decision about a specific preference sensitive recommendation from a guideline. The use and effectiveness of patient decision aids have primarily been evaluated in the context of management decisions, such as oncological or orthopaedic treatment. However, evidence for decision aids regarding testing is limited, although promising studies are being undertaken [33]. This is important, since research has shown that the current practices for communicating the downsides of testing are suboptimal. For example, decision aids used to support shared decision-making on prostate cancer screening often lack information on possible overdiagnosis [34]. Additionally, evidence suggests that the application of shared decision-making can be improved, particularly among people with limited health literacy [35]. It is important to raise awareness about the downsides of testing not only in scientific and official healthcare publications but also in lay press. For-profit testing centers tend to avoid communicating the harms and other negative consequences of testing, and information about the downsides of testing has not yet reached a wide audience of healthcare consumers [36, 37]. Additional publications in public media could raise awareness and comprehension of the significance of the advantages and disadvantages of testing, promoting rational testing and potentially decreasing both under- and overtesting. Overdiagnosis In healthcare, there is a growing recognition that excessive healthcare interventions may result in avoidable costs and potentially harm for patients and other healthcare consumers. The Choosing Wisely initiative, which encourages discussions between healthcare professionals and patients regarding commonly used treatments and tests lacking strong supporting evidence, has raised awareness of this issue [38]. However, its implementation is lagging behind [39]. As awareness of low-value care has increased, so has attention to overdiagnosis. This refers to the identification of problems that are not causing harm or the medicalisation of ordinary events or results through expanded definitions of diseases. This can cause more harm than benefit [40]:
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