Personalised risk communication for informed decision making about taking screening tests

Cardiff University, Dept of General Practice, Centre for Health Services Research, 2nd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 4(4):CD001865. DOI: 10.1002/14651858.CD001865.pub2
Source: PubMed


Screening tests aim to identify people who may have a particular disease or condition. People considering participation in screening may receive information about the general risk of having the disease or condition, or information that is tailored to their personal risk status (personalised risk information). This updated review of trials found that people given personalised risk information may be more likely to participate in screening. However, there is not enough evidence to show whether people given personalised risk information are making more informed decisions. Providing risk information in ways that better inform people may sometimes lead to lower participation rates in screening.

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    • "Some systematic reviews since then have focused on a specific type of screening, such as Cochrane reviews on interventions for increasing the uptake of breast or cervical screening [17-19], while others have concentrated on specific types of interventions, for example the Cochrane reviews concerning “personalized risk communication” [20] or “patient decision aids” [21]. Others still have examined specific populations [22], and finally, some have investigated outcomes related to participation, like the impact of female screening on future behaviours and health beliefs of women [23], or the impact of interventions to improve attendance to female cancer screening among lower socioeconomic groups [24]. "
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    ABSTRACT: The European Community recommends the implementation of population-based screening programmes for cervical, breast, and colorectal cancers. This recommendation is supported by many observational studies showing that organised programmes effectively reduce mortality and control the inappropriate use of screening tests. We conducted a systematic review of studies assessing the efficacy of interventions to increase participation in organised population-based screening programs. We included all studies on interventions aimed at increasing screening participation published between 1/1999 and 7/2012. For those published before 1999, we considered the Jepson et al. (2000) review (Health Technol Assess 4:1-133, 2000). Including studies from the Jepson review, we found 69 with quantitative information on interventions in organised screening: 19 for cervical, 26 for breast, 20 colorectal cancers, and 4 for cervical and breast cancer together. Effective interventions were: postal (breast RR = 1,37 95% Confidence Interval (95% CI): 1.25-1.51; cervical RR = 1.71 95% CI: 1.60-1.83; colorectal RR = 1.33 95% CI: 1.17-1.51) and telephone reminders (with heterogeneous methods for implementation); GP’s signature on invitation letter (breast RR = 1.13 95% CI: 1.11-1.16; cervical RR = 1.20 95% CI: 1.10-1.30; colorectal RR = 1.15 95% CI: 1.07-1.24); scheduled appointment instead of open appointment (breast RR = 1.26 95% CI: 1.02-1.55; cervical RR = 1.49 95% CI: 1.27-1.75; colorectal RR = 1.79 95% CI: 1.65-1.93). Mailing a kit for self-sampling cervical specimens increased participation in non-responders (RR = 2.37 95% CI: 1.44-3.90). Although some interventions did prove to be effective, some specific variables may influence their effectiveness in and applicability to organised population-based screening programs.
    Full-text · Article · May 2013 · BMC Public Health
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    • "Risks can be personalized based on individual risk factors for a condition (such as age or family history), or it can be calculated using formulae derived from epidemiological data [36]. A review on the effectiveness of personalized risk communication in the context of screening showed little impact of this strategy to promote informed decision making [36], but another study reported primary care practitioners preferred personalized risks [37]. "
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    ABSTRACT: Background This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together. Methods Seven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb’s seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings. Results Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users’ first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes’ purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool’s purpose. Information about the risks and benefits according to risk levels was added to the Decision Boxes, to try to ease the adaptation of the information to individual patients. Conclusion Results will guide the development of the eight remaining Decision Boxes. A future study will evaluate the effect of Decision Boxes on the integration of evidence-based and shared decision making principles in clinical practice.
    Full-text · Article · Aug 2012 · Implementation Science
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    • "In the latter, the information is often presented as an absolute risk or as a risk score, or categorised into, for example, high-, medium-, or low-risk groups. Personalised risk communication may also be less detailed, for example, a listing of a consumer’s risk factors to guide discussion and intervention [56]. In their Cochrane review, Kinnersley and colleagues operationalise communication before consultations to include any intervention delivered before consultations, and which has been designed to help consumers (and/or their representatives) address their information needs within consultations [57]. "
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    ABSTRACT: One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers. There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.
    Full-text · Article · May 2012 · Implementation Science
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