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Meta-Analysis
. 2013 Feb 28;2013(2):CD001865.
doi: 10.1002/14651858.CD001865.pub3.

Personalised risk communication for informed decision making about taking screening tests

Adrian G K Edwards  1 , Gurudutt Naik, Harry Ahmed, Glyn J Elwyn, Timothy Pickles, Kerry Hood, Rebecca Playle
Affiliations
Meta-Analysis

Personalised risk communication for informed decision making about taking screening tests

Adrian G K Edwards et al. Cochrane Database Syst Rev. .

Abstract

Background: There is a trend towards greater patient involvement in healthcare decisions. Although screening is usually perceived as good for the health of the population, there are risks associated with the tests involved. Achieving both adequate involvement of consumers and informed decision making are now seen as important goals for screening programmes. Personalised risk estimates have been shown to be effective methods of risk communication.

Objectives: To assess the effects of personalised risk communication on informed decision making by individuals taking screening tests. We also assess individual components that constitute informed decisions.

Search methods: Two authors searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2012), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHOST) and PsycINFO (OvidSP) without language restrictions. We searched from 2006 to March 2012. The date ranges for the previous searches were from 1989 to December 2005 for PsycINFO and from 1985 to December 2005 for other databases. For the original version of this review, we also searched CancerLit and Science Citation Index (March 2001). We also reviewed the reference lists and conducted citation searches of included studies and other systematic reviews in the field, to identify any studies missed during the initial search.

Selection criteria: Randomised controlled trials incorporating an intervention with a 'personalised risk communication element' for individuals undergoing screening procedures, and reporting measures of informed decisions and also cognitive, affective, or behavioural outcomes addressing the decision by such individuals, of whether or not to undergo screening.

Data collection and analysis: Two authors independently assessed each included trial for risk of bias, and extracted data. We extracted data about the nature and setting of interventions, and relevant outcome data. We used standard statistical methods to combine data using RevMan version 5, including analysis according to different levels of detail of personalised risk communication, different conditions for screening, and studies based only on high-risk participants rather than people at 'average' risk.

Main results: We included 41 studies involving 28,700 people. Nineteen new studies were identified in this update, adding to the 22 studies included in the previous two iterations of the review. Three studies measured informed decision with regard to the uptake of screening following personalised risk communication as a part of their intervention. All of these three studies were at low risk of bias and there was strong evidence that the interventions enhanced informed decision making, although with heterogeneous results. Overall 45.2% (592/1309) of participants who received personalised risk information made informed choices, compared to 20.2% (229/1135) of participants who received generic risk information. The overall odds ratios (ORs) for informed decision were 4.48 (95% confidence interval (CI) 3.62 to 5.53 for fixed effect) and 3.65 (95% CI 2.13 to 6.23 for random effects). Nine studies measured increase in knowledge, using different scales. All of these studies showed an increase in knowledge with personalised risk communication. In three studies the interventions showed a trend towards more accurate risk perception, but the evidence was of poor quality. Four out of six studies reported non-significant changes in anxiety following personalised risk communication to the participants. Overall there was a small non-significant decrease in the anxiety scores. Most studies (32/41) measured the uptake of screening tests following interventions. Our results (OR 1.15 (95% CI 1.02 to 1.29)) constitute low quality evidence, consistent with a small effect, that personalised risk communication in which a risk score was provided (6 studies) or the participants were given their categorised risk (6 studies), increases uptake of screening tests.

Authors' conclusions: There is strong evidence from three trials that personalised risk estimates incorporated within communication interventions for screening programmes enhance informed choices. However the evidence for increasing the uptake of such screening tests with similar interventions is weak, and it is not clear if this increase is associated with informed choices. Studies included a diverse range of screening programmes. Therefore, data from this review do not allow us to draw conclusions about the best interventions to deliver personalised risk communication for enhancing informed decisions. The results are dominated by findings from the topic area of mammography and colorectal cancer. Caution is therefore required in generalising from these results, and particularly for clinical topics other than mammography and colorectal cancer screening.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram. Search dates from 2006 to March 2012.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 1 Informed decision.
1.2
1.2. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 2 knowledge regarding screening test / condition concerned.
1.3
1.3. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 3 knowledge regarding screening test / condition concerned‐ proportion with good knowledge.
1.4
1.4. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 4 knowledge regarding screening test / condition concerned‐ proportion with good knowledge.
1.5
1.5. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 5 accurately perceived risk.
1.6
1.6. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 6 perceived risk ‐ perceiving self as appropriate candidate for test.
1.7
1.7. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 7 Anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).
1.8
1.8. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 8 decision conflict (proportion with lower scores).
1.9
1.9. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 9 decision conflict.
1.10
1.10. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 10 satisfaction with decision.
1.11
1.11. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 11 intention to take screening test.
1.12
1.12. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 12 intention to take genetic screening test in normal risk patients.
1.13
1.13. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 13 intention to take genetic screening test in normal risk patients.
1.14
1.14. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 14 uptake of screening test.
1.15
1.15. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 15 uptake of screening test.
1.16
1.16. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 16 appropriate use of cholesterol test.
1.17
1.17. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 17 improvement in risk comprehension/perception.
1.19
1.19. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 19 making a recommended behaviour change.
1.20
1.20. Analysis
Comparison 1 personalised risk communication versus general risk information, Outcome 20 Quality of life (SF‐36).
2.1
2.1. Analysis
Comparison 2 personalised risk communication versus general risk information for PAP SMEARS, Outcome 1 intention to take screening test.
2.2
2.2. Analysis
Comparison 2 personalised risk communication versus general risk information for PAP SMEARS, Outcome 2 uptake of screening test.
3.1
3.1. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 1 knowledge regarding screening test / condition concerned.
3.2
3.2. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 2 accuracy of perceived risk.
3.3
3.3. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 3 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).
3.4
3.4. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 4 intention to take screening test.
3.5
3.5. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 5 uptake of screening test.
3.6
3.6. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 6 uptake of screening test.
3.7
3.7. Analysis
Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 7 uptake of screening test.
4.1
4.1. Analysis
Comparison 4 personalised risk communication versus general risk information for CHOLESTEROL TESTS, Outcome 1 uptake of screening test.
4.2
4.2. Analysis
Comparison 4 personalised risk communication versus general risk information for CHOLESTEROL TESTS, Outcome 2 appropriate use of cholesterol test.
5.1
5.1. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 1 knowledge regarding screening test / condition concerned.
5.2
5.2. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 2 perceived risk ‐ perceiving self as appropriate candidate for test.
5.3
5.3. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 3 accurately perceived risk.
5.4
5.4. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 4 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).
5.5
5.5. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 5 intention to take screening test.
5.6
5.6. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 6 uptake of screening test.
5.7
5.7. Analysis
Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 7 uptake of screening test.
6.1
6.1. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 1 Informed decision.
6.2
6.2. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 2 knowledge regarding screening test / condition concerned.
6.3
6.3. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 3 knowledge regarding screening test / condition concerned.
6.4
6.4. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 4 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).
6.5
6.5. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 5 satisfaction with decision.
6.6
6.6. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 6 Decision conflict (proportion with low scores).
6.7
6.7. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 7 intention to take screening test.
6.8
6.8. Analysis
Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 8 uptake of screening test.
7.1
7.1. Analysis
Comparison 7 personalised risk communication versus general risk information for PROSTATE CANCER SCREENING, Outcome 1 uptake of screening test.
8.1
8.1. Analysis
Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 1 knowledge regarding screening test / condition concerned (Generic Inverse Variance).
8.2
8.2. Analysis
Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 2 intention to take screening test.
8.3
8.3. Analysis
Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 3 uptake of screening test.
9.1
9.1. Analysis
Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 1 Informed decision.
9.2
9.2. Analysis
Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 2 knowledge regarding screening test / condition concerned.
9.3
9.3. Analysis
Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 3 uptake of screening test.
9.4
9.4. Analysis
Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 4 anxiety.
9.5
9.5. Analysis
Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 5 decision conflict.
See this image and copyright information in PMC

Update of

Comment in

References

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