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Effects of communicating individual risks in screening programmes: Cochrane systematic review

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7417.703 (Published 25 September 2003) Cite this as: BMJ 2003;327:703
  1. Adrian Edwards, reader (a.g.k.edwards{at}swan.ac.uk)1,
  2. Silvana Unigwe, medical student2,
  3. Glyn Elwyn, professor1,
  4. Kerenza Hood, senior lecturer in statistics2
  1. 1Department of Primary Care, University of Wales Swansea Clinical School, Singleton Park, Swansea SA2 8PP
  2. 2Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff CF23 9PN
  1. Correspondence to: A Edwards

    Abstract

    Abstract Objective To assess the effects of different types of individualised risk communication for patients who are deciding whether to participate in screening.

    Design Systematic review.

    Data sources Specialist register of the Cochrane consumers and communication review group, scientific databases, and a manual follow up of references.

    Selection of studies Studies were randomised controlled trials addressing decisions by patients whether or not to undergo screening and incorporating an intervention with an element of “individualised” risk communication–based on the individual's own risk factors for a condition (such as age or family history).

    Outcome measures The principal outcome was uptake of screening tests; further cognitive and affective measures were also assessed to gauge informed decision making.

    Results 13 studies were included, 10 of which addressed mammography programmes. Individualised risk communication was associated with an increased uptake of screening tests (odds ratio 1.5, 95% confidence interval 1.11 to 2.03). Few cognitive or affective outcomes were reported consistently, so it was not possible to conclude whether this increase in the uptake of tests was related to informed decision making by patients.

    Conclusions Individualised risk estimates may be effective for purposes of population health, but their effects on increasing uptake of screening programmes may not be interpretable as evidence of informed decision making by patients. Greater attention is required to ways of developing interventions for screening programmes that can achieve this.

    Footnotes

    • Contributors AE designed the protocol, assessed studies for inclusion and data extraction, and led the drafting of this report. SU conducted the literature searches, assessed studies for inclusion and data extraction, and contributed to the drafting of this report. GE contributed to protocol design, was a third reviewer for inclusion and data extraction where required, and contributed to the drafting of this report. KH contributed to protocol design, the statistical data extraction and analysis, and contributed to the drafting of this report. AE is the guarantor.

    • Funding Cochrane Health Promotion and Public Health Field.

    • Competing interests None declared

    • Note about process AE is the guest editor for this theme issue of the BMJ but he submitted this research to the BMJ in the normal way and it was handled through the BMJ ‘s normal decision making mechanisms. He played no part in the decision making over this paper.

    • A fuller version of this review and its findings is available through the Cochrane Library. Issue 1. Update Software, 2003. (Consumers and Communication Review Group.)

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