Scolaris Content Display Scolaris Content Display

Study flow diagram. Search dates from 2006 to March 2012.
Figures and Tables -
Figure 1

Study flow diagram. Search dates from 2006 to March 2012.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 personalised risk communication versus general risk information, Outcome 1 Informed decision.
Figures and Tables -
Analysis 1.1

Comparison 1 personalised risk communication versus general risk information, Outcome 1 Informed decision.

Comparison 1 personalised risk communication versus general risk information, Outcome 2 knowledge regarding screening test / condition concerned.
Figures and Tables -
Analysis 1.2

Comparison 1 personalised risk communication versus general risk information, Outcome 2 knowledge regarding screening test / condition concerned.

Comparison 1 personalised risk communication versus general risk information, Outcome 3 knowledge regarding screening test / condition concerned‐ proportion with good knowledge.
Figures and Tables -
Analysis 1.3

Comparison 1 personalised risk communication versus general risk information, Outcome 3 knowledge regarding screening test / condition concerned‐ proportion with good knowledge.

Comparison 1 personalised risk communication versus general risk information, Outcome 4 knowledge regarding screening test / condition concerned‐ proportion with good knowledge.
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Analysis 1.4

Comparison 1 personalised risk communication versus general risk information, Outcome 4 knowledge regarding screening test / condition concerned‐ proportion with good knowledge.

Comparison 1 personalised risk communication versus general risk information, Outcome 5 accurately perceived risk.
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Analysis 1.5

Comparison 1 personalised risk communication versus general risk information, Outcome 5 accurately perceived risk.

Comparison 1 personalised risk communication versus general risk information, Outcome 6 perceived risk ‐ perceiving self as appropriate candidate for test.
Figures and Tables -
Analysis 1.6

Comparison 1 personalised risk communication versus general risk information, Outcome 6 perceived risk ‐ perceiving self as appropriate candidate for test.

Comparison 1 personalised risk communication versus general risk information, Outcome 7 Anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).
Figures and Tables -
Analysis 1.7

Comparison 1 personalised risk communication versus general risk information, Outcome 7 Anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).

Comparison 1 personalised risk communication versus general risk information, Outcome 8 decision conflict (proportion with lower scores).
Figures and Tables -
Analysis 1.8

Comparison 1 personalised risk communication versus general risk information, Outcome 8 decision conflict (proportion with lower scores).

Comparison 1 personalised risk communication versus general risk information, Outcome 9 decision conflict.
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Analysis 1.9

Comparison 1 personalised risk communication versus general risk information, Outcome 9 decision conflict.

Comparison 1 personalised risk communication versus general risk information, Outcome 10 satisfaction with decision.
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Analysis 1.10

Comparison 1 personalised risk communication versus general risk information, Outcome 10 satisfaction with decision.

Comparison 1 personalised risk communication versus general risk information, Outcome 11 intention to take screening test.
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Analysis 1.11

Comparison 1 personalised risk communication versus general risk information, Outcome 11 intention to take screening test.

Comparison 1 personalised risk communication versus general risk information, Outcome 12 intention to take genetic screening test in normal risk patients.
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Analysis 1.12

Comparison 1 personalised risk communication versus general risk information, Outcome 12 intention to take genetic screening test in normal risk patients.

Comparison 1 personalised risk communication versus general risk information, Outcome 13 intention to take genetic screening test in normal risk patients.
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Analysis 1.13

Comparison 1 personalised risk communication versus general risk information, Outcome 13 intention to take genetic screening test in normal risk patients.

Comparison 1 personalised risk communication versus general risk information, Outcome 14 uptake of screening test.
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Analysis 1.14

Comparison 1 personalised risk communication versus general risk information, Outcome 14 uptake of screening test.

Comparison 1 personalised risk communication versus general risk information, Outcome 15 uptake of screening test.
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Analysis 1.15

Comparison 1 personalised risk communication versus general risk information, Outcome 15 uptake of screening test.

Comparison 1 personalised risk communication versus general risk information, Outcome 16 appropriate use of cholesterol test.
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Analysis 1.16

Comparison 1 personalised risk communication versus general risk information, Outcome 16 appropriate use of cholesterol test.

Comparison 1 personalised risk communication versus general risk information, Outcome 17 improvement in risk comprehension/perception.
Figures and Tables -
Analysis 1.17

Comparison 1 personalised risk communication versus general risk information, Outcome 17 improvement in risk comprehension/perception.

Study

personal risk factor list v general information

Champion 2007

All interventions were effective (compared to usual care) in moving women forward in mammography stage (versus same or backward). However, the combination of tailored telephone and print interventions versus usual care, had the largest effect. (OR 1.949, 95% CI 1.355 to 2.815)

Rawl 2008

Forward movement of stage was:

  • 18% among risk tailored group versus 12% for control group for Faecal Occult Blood Test (FOBT)

  • 36% among risk tailored group versus 24% for control group for colonoscopic screening

Forward movement of stage was slightly higher in the risk tailored group.

Skinner 1994

71% did not change; 14% advanced one stage; 12% 'regressed': no significant differences between tailored message and control.

Figures and Tables -
Analysis 1.18

Comparison 1 personalised risk communication versus general risk information, Outcome 18 stages of change.

Comparison 1 personalised risk communication versus general risk information, Outcome 19 making a recommended behaviour change.
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Analysis 1.19

Comparison 1 personalised risk communication versus general risk information, Outcome 19 making a recommended behaviour change.

Comparison 1 personalised risk communication versus general risk information, Outcome 20 Quality of life (SF‐36).
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Analysis 1.20

Comparison 1 personalised risk communication versus general risk information, Outcome 20 Quality of life (SF‐36).

Comparison 2 personalised risk communication versus general risk information for PAP SMEARS, Outcome 1 intention to take screening test.
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Analysis 2.1

Comparison 2 personalised risk communication versus general risk information for PAP SMEARS, Outcome 1 intention to take screening test.

Comparison 2 personalised risk communication versus general risk information for PAP SMEARS, Outcome 2 uptake of screening test.
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Analysis 2.2

Comparison 2 personalised risk communication versus general risk information for PAP SMEARS, Outcome 2 uptake of screening test.

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 1 knowledge regarding screening test / condition concerned.
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Analysis 3.1

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 1 knowledge regarding screening test / condition concerned.

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 2 accuracy of perceived risk.
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Analysis 3.2

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 2 accuracy of perceived risk.

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 3 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).
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Analysis 3.3

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 3 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress).

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 4 intention to take screening test.
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Analysis 3.4

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 4 intention to take screening test.

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 5 uptake of screening test.
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Analysis 3.5

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 5 uptake of screening test.

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 6 uptake of screening test.
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Analysis 3.6

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 6 uptake of screening test.

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 7 uptake of screening test.
Figures and Tables -
Analysis 3.7

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 7 uptake of screening test.

Study

personal risk factor list v general information

Skinner 1994

71% did not change; 14% advanced one stage; 12% 'regressed': no significant differences between tailored message and control.

Figures and Tables -
Analysis 3.8

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 8 stages of change.

Comparison 4 personalised risk communication versus general risk information for CHOLESTEROL TESTS, Outcome 1 uptake of screening test.
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Analysis 4.1

Comparison 4 personalised risk communication versus general risk information for CHOLESTEROL TESTS, Outcome 1 uptake of screening test.

Comparison 4 personalised risk communication versus general risk information for CHOLESTEROL TESTS, Outcome 2 appropriate use of cholesterol test.
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Analysis 4.2

Comparison 4 personalised risk communication versus general risk information for CHOLESTEROL TESTS, Outcome 2 appropriate use of cholesterol test.

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 1 knowledge regarding screening test / condition concerned.
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Analysis 5.1

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 1 knowledge regarding screening test / condition concerned.

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 2 perceived risk ‐ perceiving self as appropriate candidate for test.
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Analysis 5.2

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 2 perceived risk ‐ perceiving self as appropriate candidate for test.

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 3 accurately perceived risk.
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Analysis 5.3

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 3 accurately perceived risk.

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).
Figures and Tables -
Analysis 5.4

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).

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 5 intention to take screening test.
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Analysis 5.5

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 5 intention to take screening test.

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 6 uptake of screening test.
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Analysis 5.6

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 6 uptake of screening test.

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 7 uptake of screening test.
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Analysis 5.7

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 7 uptake of screening test.

Study

personal risk factor list v general information

Rawl 2008

Forward movement of stage was:

  • 18% among risk tailored group versus 12% for control group for Faecal Occult Blood Test (FOBT)

  • 36% among risk tailored group versus 24% for control group for colonoscopic screening

Forward movement of stage was slightly higher in the risk tailored group.

Figures and Tables -
Analysis 5.8

Comparison 5 personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE, Outcome 8 stages of change.

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 1 Informed decision.
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Analysis 6.1

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 1 Informed decision.

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 2 knowledge regarding screening test / condition concerned.
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Analysis 6.2

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 2 knowledge regarding screening test / condition concerned.

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 3 knowledge regarding screening test / condition concerned.
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Analysis 6.3

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 3 knowledge regarding screening test / condition concerned.

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).
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Analysis 6.4

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).

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 5 satisfaction with decision.
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Analysis 6.5

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 5 satisfaction with decision.

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 6 Decision conflict (proportion with low scores).
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Analysis 6.6

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 6 Decision conflict (proportion with low scores).

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 7 intention to take screening test.
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Analysis 6.7

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 7 intention to take screening test.

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 8 uptake of screening test.
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Analysis 6.8

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 8 uptake of screening test.

Study

personal risk factor list v general information

Rawl 2008

Forward movement of stage was:

  • 18% among risk tailored group versus 12% for control group for Faecal Occult Blood Test (FOBT)

  • 36% among risk tailored group versus 24% for control group for colonoscopic screening

Forward movement of stage was slightly higher in the risk tailored group.

Figures and Tables -
Analysis 6.9

Comparison 6 personalised risk communication versus general risk information for COLORECTAL SCREENING, Outcome 9 stages of change.

Comparison 7 personalised risk communication versus general risk information for PROSTATE CANCER SCREENING, Outcome 1 uptake of screening test.
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Analysis 7.1

Comparison 7 personalised risk communication versus general risk information for PROSTATE CANCER SCREENING, Outcome 1 uptake of screening test.

Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 1 knowledge regarding screening test / condition concerned (Generic Inverse Variance).
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Analysis 8.1

Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 1 knowledge regarding screening test / condition concerned (Generic Inverse Variance).

Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 2 intention to take screening test.
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Analysis 8.2

Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 2 intention to take screening test.

Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 3 uptake of screening test.
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Analysis 8.3

Comparison 8 Personalised risk communication versus general risk information for SKIN CANCER SCREENING, Outcome 3 uptake of screening test.

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 1 Informed decision.
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Analysis 9.1

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 1 Informed decision.

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 2 knowledge regarding screening test / condition concerned.
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Analysis 9.2

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 2 knowledge regarding screening test / condition concerned.

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 3 uptake of screening test.
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Analysis 9.3

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 3 uptake of screening test.

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 4 anxiety.
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Analysis 9.4

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 4 anxiety.

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 5 decision conflict.
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Analysis 9.5

Comparison 9 Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY, Outcome 5 decision conflict.

Summary of findings for the main comparison. Personalised risk communication versus general risk information for informed decision making about taking screening tests

Patient or population: patients with informed decision making about taking screening tests
Settings: screening test in primary and secondary care setting
Intervention: personalised risk communication versus general risk information

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk8

Corresponding risk

Control

Personalised risk communication versus general risk information

Informed decision ‐ Numerical risk and categorised risk combined
MMIC1

202 per 1000

480 per 1000
(350 to 612)

OR 3.65
(2.13 to 6.23)

2444
(3 studies)

⊕⊕⊕⊕
high2,3,4,7

Random‐effects estimate presented due to significant heterogeneity

Uptake of screening test ‐ Numerical and categorised risk combined
Number of participants taking up the test

532 per 1000

566 per 1000
(537 to 594)

OR 1.15
(1.02 to 1.29)

6442
(12 studies)

⊕⊕⊝⊝
low5,6,7

Fixed‐effect estimate

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence (we have not assessed publication bias for any of the groups)
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 MMIC: Multi‐dimensional Measure of Informed Choice
2 Significant heterogeneity among studies but all studies have same direction of effect and hence not down graded.
3Good quality randomised studies with low risk of bias.
4All studies consistently demonstrating an odds ratio of > 2 and quality upgraded by one point.
5Moderate or low heterogeneity among studies and not down graded for inconsistency.
6Out of 12 studies: 5 mentioned generation of random sequence, only 2 studies mentioned concealing allocation, blinding of participants, personnel and outcome assessors was mostly unclear across studies, 9 studies were low risk for attrition bias and 5 studies were high risk for reporting bias. Quality was downgraded by 1 point.
7Personalised risk communication is delivered as a part of the interventions. Informed choice and uptake are promoted by influencing many other elements such as knowledge, perceived risk etc leading to indirectness of evidence and hence down graded by a point.

8Control risk was used as baseline risk, due to lack of studies that measure this in detail to be presented as baseline risk for the population.

Figures and Tables -
Summary of findings for the main comparison. Personalised risk communication versus general risk information for informed decision making about taking screening tests
Summary of findings 2. Personalised risk communication versus general risk information for informed decision making about taking screening tests

Patient or population: patients with informed decision making about taking screening tests
Settings: screening test in primary and secondary care setting
Intervention: personalised risk communication versus general risk information

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk10

Corresponding risk

Control

Personalised risk communication versus general risk information

Knowledge regarding screening test/condition concerned ‐ calculated risk score (numerical) versus general information
various continuous scales

The mean knowledge regarding screening test/condition concerned ‐ calculated risk score (numerical) versus general information in the intervention group was
0.4 standard deviations higher
(0.23 to 0.56 higher)

588
(1 study)

⊕⊕⊕⊝
moderate1,14

SMD 0.4 (0.23 to 0.56)

Fixed‐effect estimate

Knowledge regarding screening test/condition concerned ‐ calculated risk score (categorised) versus general information
various continuous scales

The mean knowledge regarding screening test/condition concerned ‐ calculated risk score (categorised) versus general information in the intervention group was
0.57 standard deviations higher
(0.32 to 0.82 higher)

260
(1 study)

⊕⊕⊝⊝
low2,11,14

SMD 0.57 (0.32 to 0.82)

Fixed‐effect estimate

Knowledge regarding screening test/condition concerned ‐ personal risk factor list versus general information
various continuous scales

The mean knowledge regarding screening test/condition concerned ‐ personal risk factor list versus general information in the intervention group was
0.89 standard deviations higher
(0.75 to 1.04 higher)

838
(2 studies)

⊕⊕⊕⊕
high3,14

SMD 0.89 (0.75 to 1.04)

Fixed effect estimate

Knowledge regarding screening test/condition concerned ‐ calculated risk score (numerical) versus general information
proportion with good knowledge

244 per 1000

457 per 1000
(291 to 633)

OR 2.6
(1.27 to 5.34)

1413
(3 studies)

⊕⊕⊕⊕

high4,6,13,14

Random‐effects estimate

Knowledge regarding screening test / condition concerned ‐ personal risk factor list v general information
proportion with good knowledge

166 per 1000

586 per 1000
(535 to 636)

OR 7.13
(5.79 to 8.79)

2107
(2 studies)

⊕⊕⊕⊕
high6, 12,14

Fixed‐effect estimate

Accurately‐perceived risk
proportion of participants who perceived risk accurately

225 per 1000

324 per 1000
(218 to 450)

OR 1.65
(0.96 to 2.81)

1264
(3 studies)

⊕⊕⊝⊝
low7,8,13,14

Random‐effects estimate

Anxiety ‐ all groups
various continuous scales

The mean anxiety in the intervention groups was
0.13 standard deviations lower
(0.29 lower to 0.03 higher)

1848
(6 studies)

⊕⊝⊝⊝
very low5,8,9,14

SMD ‐0.13 (‐0.29 to 0.03)

Random‐effects estimate

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence (we have not assessed publication bias for any of the groups)
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 This study was high risk for reporting bias. Four risk of bias items were low risk and four were unclear risk. Quality down graded by a point.
2 Seven out of nine risk of bias items were unclear. Quality down graded by a point.
3 One out of two studies included in this analysis was of very good quality. The other study had mostly unclear risk of bias. Overall we have not downgraded the quality for this analysis.
4 Two out of three studies had more than four risk of bias items assessed as low risk. The other study had most unclear risk of bias items. Overall quality was not downgraded.
5 Substantial/significant heterogeneity of results exists and all studies did not show similar direction of effect. Quality down graded by a point.
6 Consistently large effects favouring personalised risk communication and hence upgraded the quality by one point.
7 Most risk of bias items were unclear with some high risk items. Quality downgraded by one point.
8 Pooled estimate includes no effect and hence down graded by one point.
9 Two out of six studies had more than four risk of bias items assessed as low risk. The remaining studies had most risk of bias items assessed as unclear. Quality downgraded by one point.

10Control risk was used as baseline risk due to lack of studies that measure this in detail to be presented as baseline risk for the population.

11Sample size less than the Optimal Information size (OIS). Quality downgraded by one point.

12Both studies were of low risk of bias and hence not downgraded.

13Significant heterogeneity among studies but all studies have same direction of effect and hence quality not down graded.

14Not downgraded for indirectness of evidence.

Figures and Tables -
Summary of findings 2. Personalised risk communication versus general risk information for informed decision making about taking screening tests
Comparison 1. personalised risk communication versus general risk information

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Informed decision Show forest plot

3

2444

Odds Ratio (Fixed, 95% CI)

4.48 [3.62, 5.53]

1.1 calculated risk score (numerical) v general information

1

338

Odds Ratio (Fixed, 95% CI)

2.08 [1.14, 3.81]

1.2 personal risk factor list v general information

2

2106

Odds Ratio (Fixed, 95% CI)

4.98 [3.97, 6.24]

2 knowledge regarding screening test / condition concerned Show forest plot

4

Std. Mean Difference (Fixed, 95% CI)

Subtotals only

2.1 calculated risk score (numerical) v general information

1

588

Std. Mean Difference (Fixed, 95% CI)

0.40 [0.23, 0.56]

2.2 calculated risk score (categorised) v general information

1

260

Std. Mean Difference (Fixed, 95% CI)

0.57 [0.32, 0.82]

2.3 personal risk factor list v general information

2

838

Std. Mean Difference (Fixed, 95% CI)

0.89 [0.75, 1.04]

3 knowledge regarding screening test / condition concerned‐ proportion with good knowledge Show forest plot

3

Odds Ratio (Random, 95% CI)

Subtotals only

3.1 calculated risk score (numerical) v general information

3

1413

Odds Ratio (Random, 95% CI)

2.60 [1.27, 5.34]

4 knowledge regarding screening test / condition concerned‐ proportion with good knowledge Show forest plot

2

2107

Odds Ratio (Fixed, 95% CI)

7.13 [5.79, 8.79]

4.1 personal risk factor list v general information

2

2107

Odds Ratio (Fixed, 95% CI)

7.13 [5.79, 8.79]

5 accurately perceived risk Show forest plot

3

1264

Odds Ratio (M‐H, Random, 95% CI)

1.65 [0.96, 2.81]

5.1 calculated risk score (numerical) v general information

2

1004

Odds Ratio (M‐H, Random, 95% CI)

1.22 [0.91, 1.64]

5.2 calculated risk score (categorised) v general information

1

260

Odds Ratio (M‐H, Random, 95% CI)

2.50 [1.48, 4.20]

6 perceived risk ‐ perceiving self as appropriate candidate for test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress) Show forest plot

6

1848

Std. Mean Difference (Random, 95% CI)

‐0.13 [‐0.29, 0.03]

7.1 calculated risk score (numerical) v general information

4

1058

Std. Mean Difference (Random, 95% CI)

‐0.19 [‐0.42, 0.04]

7.2 calculated risk score (categorised) v general information

1

260

Std. Mean Difference (Random, 95% CI)

0.0 [‐0.24, 0.24]

7.3 personal risk factor list v general information

1

530

Std. Mean Difference (Random, 95% CI)

‐0.02 [‐0.20, 0.16]

8 decision conflict (proportion with lower scores) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 decision conflict Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

9.1 calculated risk score (numerical) v general information

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

10 satisfaction with decision Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 personal risk factor list v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 intention to take screening test Show forest plot

7

Odds Ratio (Random, 95% CI)

Totals not selected

11.1 calculated risk score (numerical) v general information

1

Odds Ratio (Random, 95% CI)

0.0 [0.0, 0.0]

11.2 calculated risk score (categorised) v general information

3

Odds Ratio (Random, 95% CI)

0.0 [0.0, 0.0]

11.3 personal risk factor list v general information

3

Odds Ratio (Random, 95% CI)

0.0 [0.0, 0.0]

12 intention to take genetic screening test in normal risk patients Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

12.1 calculated risk score (numerical)

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 intention to take genetic screening test in normal risk patients Show forest plot

2

Mean Difference (Random, 95% CI)

‐0.77 [‐1.42, ‐0.13]

13.1 calculated risk score (numerical)

1

Mean Difference (Random, 95% CI)

‐0.52 [‐0.61, ‐0.43]

13.2 calculated risk score (categorised)

1

Mean Difference (Random, 95% CI)

‐1.2 [‐1.88, ‐0.52]

14 uptake of screening test Show forest plot

12

6442

Odds Ratio (Fixed, 95% CI)

1.15 [1.02, 1.29]

14.1 calculated risk score (numerical) v general information

6

2569

Odds Ratio (Fixed, 95% CI)

0.95 [0.78, 1.15]

14.2 calculated risk score (categorised) v general information

6

3873

Odds Ratio (Fixed, 95% CI)

1.29 [1.11, 1.51]

15 uptake of screening test Show forest plot

20

Odds Ratio (Random, 95% CI)

Totals not selected

15.1 personal risk factor list v general information

20

Odds Ratio (Random, 95% CI)

0.0 [0.0, 0.0]

16 appropriate use of cholesterol test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

16.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17 improvement in risk comprehension/perception Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

17.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 stages of change Show forest plot

Other data

No numeric data

18.1 personal risk factor list v general information

Other data

No numeric data

19 making a recommended behaviour change Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

19.1 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20 Quality of life (SF‐36) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

20.1 calculated risk score (categorised) v general information

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. personalised risk communication versus general risk information
Comparison 2. personalised risk communication versus general risk information for PAP SMEARS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 intention to take screening test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 uptake of screening test Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 personal risk factor list v general information

2

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. personalised risk communication versus general risk information for PAP SMEARS
Comparison 3. personalised risk communication versus general risk information for MAMMOGRAPHY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 knowledge regarding screening test / condition concerned Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 accuracy of perceived risk Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 calculated risk score (numerical) v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 intention to take screening test Show forest plot

2

Odds Ratio (Fixed, 95% CI)

Totals not selected

4.1 calculated risk score (categorised) v general information

1

Odds Ratio (Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 personal risk factor list v general information

1

Odds Ratio (Fixed, 95% CI)

0.0 [0.0, 0.0]

5 uptake of screening test Show forest plot

4

1595

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.68, 1.03]

5.1 calculated risk score (numerical) v general information

4

1595

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.68, 1.03]

6 uptake of screening test Show forest plot

3

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

6.1 calculated risk score (categorised) v general information

3

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 uptake of screening test Show forest plot

8

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

7.1 personal risk factor list v general information

8

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 stages of change Show forest plot

Other data

No numeric data

8.1 personal risk factor list v general information

Other data

No numeric data

Figures and Tables -
Comparison 3. personalised risk communication versus general risk information for MAMMOGRAPHY
Comparison 4. personalised risk communication versus general risk information for CHOLESTEROL TESTS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 uptake of screening test Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 calculated risk score (categorised) v general information

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 appropriate use of cholesterol test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. personalised risk communication versus general risk information for CHOLESTEROL TESTS
Comparison 5. personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 knowledge regarding screening test / condition concerned Show forest plot

3

1156

Std. Mean Difference (Fixed, 95% CI)

0.59 [0.47, 0.71]

1.1 calculated risk score (numerical) v general information

1

588

Std. Mean Difference (Fixed, 95% CI)

0.40 [0.23, 0.56]

1.2 calculated risk score (categorised) v general information

1

260

Std. Mean Difference (Fixed, 95% CI)

0.57 [0.32, 0.82]

1.3 personal risk factor list v general information

1

308

Std. Mean Difference (Fixed, 95% CI)

1.02 [0.78, 1.26]

2 perceived risk ‐ perceiving self as appropriate candidate for test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 accurately perceived risk Show forest plot

2

460

Odds Ratio (M‐H, Fixed, 95% CI)

2.25 [1.44, 3.53]

3.1 calculated risk score (numerical) v general information

1

200

Odds Ratio (M‐H, Fixed, 95% CI)

1.69 [0.70, 4.06]

3.2 calculated risk score (categorised) v general information

1

260

Odds Ratio (M‐H, Fixed, 95% CI)

2.50 [1.48, 4.20]

4 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress) Show forest plot

3

662

Mean Difference (IV, Fixed, 95% CI)

0.07 [‐0.14, 0.28]

4.1 calculated risk score (numerical) v general information

2

402

Mean Difference (IV, Fixed, 95% CI)

0.16 [‐0.16, 0.48]

4.2 calculated risk score (categorised) v general information

1

260

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.28, 0.28]

5 intention to take screening test Show forest plot

3

854

Odds Ratio (Fixed, 95% CI)

1.29 [0.97, 1.72]

5.1 calculated risk score (categorised) v general information

1

260

Odds Ratio (Fixed, 95% CI)

0.21 [0.07, 0.64]

5.2 personal risk factor list v general information

2

594

Odds Ratio (Fixed, 95% CI)

1.47 [1.09, 1.97]

6 uptake of screening test Show forest plot

5

2085

Odds Ratio (Fixed, 95% CI)

1.22 [1.00, 1.48]

6.1 calculated risk score (numerical) v general information

3

1156

Odds Ratio (Fixed, 95% CI)

1.05 [0.79, 1.40]

6.2 calculated risk score (categorised) v general information

2

929

Odds Ratio (Fixed, 95% CI)

1.38 [1.06, 1.80]

7 uptake of screening test Show forest plot

7

Odds Ratio (Random, 95% CI)

Totals not selected

7.1 personal risk factor list v general information

7

Odds Ratio (Random, 95% CI)

0.0 [0.0, 0.0]

8 stages of change Show forest plot

Other data

No numeric data

8.1 personal risk factor list v general information

Other data

No numeric data

Figures and Tables -
Comparison 5. personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE
Comparison 6. personalised risk communication versus general risk information for COLORECTAL SCREENING

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Informed decision Show forest plot

2

2107

Odds Ratio (Fixed, 95% CI)

4.99 [3.98, 6.25]

1.1 personal risk factor list v general information

2

2107

Odds Ratio (Fixed, 95% CI)

4.99 [3.98, 6.25]

2 knowledge regarding screening test / condition concerned Show forest plot

3

2378

Odds Ratio (M‐H, Fixed, 95% CI)

6.81 [5.57, 8.34]

2.1 calculated risk score (numerical) v general information

1

271

Odds Ratio (M‐H, Fixed, 95% CI)

4.26 [1.86, 9.74]

2.2 personal risk factor list v general information

2

2107

Odds Ratio (M‐H, Fixed, 95% CI)

7.04 [5.72, 8.67]

3 knowledge regarding screening test / condition concerned Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 personal risk factor list v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 anxiety (Cancer related anxiety and helplessness scale; IES breast cancer distress) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 personal risk factor list v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 satisfaction with decision Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 personal risk factor list v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Decision conflict (proportion with low scores) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 intention to take screening test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 calculated risk score (numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 uptake of screening test Show forest plot

10

5567

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.82, 1.37]

8.1 calculated risk score (numerical) v general information

1

271

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.28, 2.17]

8.2 calculated risk score (categorised) v general information

3

1557

Odds Ratio (M‐H, Random, 95% CI)

1.34 [1.01, 1.77]

8.3 personal risk factor list v general information

6

3739

Odds Ratio (M‐H, Random, 95% CI)

0.96 [0.68, 1.35]

9 stages of change Show forest plot

Other data

No numeric data

9.1 personal risk factor list v general information

Other data

No numeric data

Figures and Tables -
Comparison 6. personalised risk communication versus general risk information for COLORECTAL SCREENING
Comparison 7. personalised risk communication versus general risk information for PROSTATE CANCER SCREENING

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 uptake of screening test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 personal risk factor list v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 7. personalised risk communication versus general risk information for PROSTATE CANCER SCREENING
Comparison 8. Personalised risk communication versus general risk information for SKIN CANCER SCREENING

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 knowledge regarding screening test / condition concerned (Generic Inverse Variance) Show forest plot

1

Std. Mean Difference (Fixed, 95% CI)

Totals not selected

1.1 calculated risk score(numerical) v general information

1

Std. Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

2 intention to take screening test Show forest plot

1

Odds Ratio (Fixed, 95% CI)

Totals not selected

2.1 Personal risk factor list v general information

1

Odds Ratio (Fixed, 95% CI)

0.0 [0.0, 0.0]

3 uptake of screening test Show forest plot

3

1284

Odds Ratio (Fixed, 95% CI)

1.69 [1.32, 2.18]

3.1 calculated risk score(numerical) v general information

1

587

Odds Ratio (Fixed, 95% CI)

1.67 [1.04, 2.69]

3.2 personal risk factor list v general information

2

697

Odds Ratio (Fixed, 95% CI)

1.70 [1.26, 2.29]

Figures and Tables -
Comparison 8. Personalised risk communication versus general risk information for SKIN CANCER SCREENING
Comparison 9. Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Informed decision Show forest plot

1

338

Odds Ratio (Fixed, 95% CI)

2.08 [1.14, 3.81]

1.1 calculated risk score(numerical) v general information

1

338

Odds Ratio (Fixed, 95% CI)

2.08 [1.14, 3.81]

2 knowledge regarding screening test / condition concerned Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 calculated risk score(numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 uptake of screening test Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 calculated risk score(numerical) v general information

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 anxiety Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 calculated risk score(numerical) v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 decision conflict Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 calculated risk score(numerical) v general information

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 9. Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY