The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysisBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1102 (Published 15 March 2016) Cite this as: BMJ 2016;352:i1102
- Gareth J Hollands, senior research associate1,
- David P French, professor of health psychology2,
- Simon J Griffin, professor of general practice3,
- A Toby Prevost, professor of medical statistics and clinical trials4,
- Stephen Sutton, professor of behavioural science3,
- Sarah King, visiting fellow1,
- Theresa M Marteau, director and professor of behaviour and health1
- 1Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
- 2School of Psychological Sciences, University of Manchester, Manchester, UK
- 3Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- 4Imperial Clinical Trials Unit, Imperial College London, London, UK
- Correspondence to: T M Marteau
- Accepted 14 February 2016
Objective To assess the impact of communicating DNA based disease risk estimates on risk-reducing health behaviours and motivation to engage in such behaviours.
Design Systematic review with meta-analysis, using Cochrane methods.
Data sources Medline, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials up to 25 February 2015. Backward and forward citation searches were also conducted.
Study selection Randomised and quasi-randomised controlled trials involving adults in which one group received personalised DNA based estimates of disease risk for conditions where risk could be reduced by behaviour change. Eligible studies included a measure of risk-reducing behaviour.
Results We examined 10 515 abstracts and included 18 studies that reported on seven behavioural outcomes, including smoking cessation (six studies; n=2663), diet (seven studies; n=1784), and physical activity (six studies; n=1704). Meta-analysis revealed no significant effects of communicating DNA based risk estimates on smoking cessation (odds ratio 0.92, 95% confidence interval 0.63 to 1.35, P=0.67), diet (standardised mean difference 0.12, 95% confidence interval −0.00 to 0.24, P=0.05), or physical activity (standardised mean difference −0.03, 95% confidence interval −0.13 to 0.08, P=0.62). There were also no effects on any other behaviours (alcohol use, medication use, sun protection behaviours, and attendance at screening or behavioural support programmes) or on motivation to change behaviour, and no adverse effects, such as depression and anxiety. Subgroup analyses provided no clear evidence that communication of a risk-conferring genotype affected behaviour more than communication of the absence of such a genotype. However, studies were predominantly at high or unclear risk of bias, and evidence was typically of low quality.
Conclusions Expectations that communicating DNA based risk estimates changes behaviour is not supported by existing evidence. These results do not support use of genetic testing or the search for risk-conferring gene variants for common complex diseases on the basis that they motivate risk-reducing behaviour.
Systematic review registration This is a revised and updated version of a Cochrane review from 2010, adding 11 studies to the seven previously identified.
We thank Barb Biesecker and Hilary Burton for their helpful comments on a draft of this paper.
Contributors: GJH, SK, and TMM searched for, screened, and selected studies. All authors extracted data. GJH, SK, ATP, and TMM conducted the analysis. All authors interpreted the analysis, drafted the final manuscript, and read and approved the final version. TMM is the guarantor.
Funding: A previous version of this review was funded as part of a grant from the Medical Research Council, UK (Risk communication in preventive medicine: optimising the impact of DNA risk information; G0500274). Updating this review was funded by a National Institute for Health Research senior investigator award to TMM. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Competing interests: GJH, SJG, ATP, SS, and TMM were authors on at least one of the included studies. These authors were not involved in decisions regarding the inclusion of these studies nor in the extraction of data from these studies. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: All data used for the review are available from the authors.
Transparency: The manuscript’s guarantor (TMM) had full access to all of the data in the review and takes responsibility for the integrity of the data and accuracy of the data analysis. She accepts full responsibility for the conduct of the review and has controlled the decision to publish. She affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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