I am a carer, looking after someone who lacks the mental capacity to make their own decisions about screening. They have been invited for screening. How should I deal with their invitation?

If the person you care for is unable to make their own decisions about screening, then you, as their carer, should make what is called a ‘best interests’ decision on their behalf, in the same way as you may be making other decisions about their care and treatment. You will need to weigh up the benefits of screening, the possible harm to them and what you think the person would have wanted to do themselves. Whether you are a paid carer, or an unpaid carer, family member or close friend, the process is the same.

Some people may have fluctuating mental capacity, in which case, the decision about screening should be delayed until the individual is able to decide for themselves.

If you do need to make a decision on someone else’s behalf, you will need to consider what is involved in the screening process (including any further diagnostic tests that may be needed if the person receives an abnormal screening result). You may find it helpful to speak to their GP to discuss, for example, the person’s risk of developing the cancer in question and how screening may affect them.

You must also consider what you think the person themselves would want. For example, did they used to go to screening, or express an opinion about it? Did they express more general views about their health and whether they would want to know if they had a disease or condition? Or did they refuse screening in the past? Paid carers in particular should get advice from family members or friends about the person’s views. If, after all this, you consider that screening is in the best interests of the person you care for, then you are within your rights to help that person to be screened. You should feel confident that if someone asks you, you will be able to explain the reasons for the best interests decision that you have made – either for, or against, screening.

To find out about the breast screening process, please read our leaflet NHS Breast Screening and additional information can be found in the Macmillan booklet Understanding breast screening.

To help someone with limited capacity to understand the screening process, you may find the picture leaflet An easy guide to breast screening helpful.

To find out more on making a best interests decision, the following publications are available from the Office of the Public Guardian;

Making decisions: A guide for family, friends and other unpaid carers (PDF 390Kb).

Making decisions: A guide for people who work in health and social care (PDF 320Kb).

To find out more about consenting to screening, please read our Consent to cancer screening guidance.

To find out more general information regarding consent and access to screening, please refer to our guidance Equal access to breast and cervical screening for disabled women.