Personalised risk communication for informed decision making about taking screening tests

Adrian GK Edwards; Gurudutt Naik; Harry Ahmed; Glyn J Elwyn; Timothy Pickles; Kerry Hood; Rebecca Playle

doi:10.1002/14651858.CD001865.pub3

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Figure 1

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

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Figure 2

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

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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.

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

Comparison 1 personalised risk communication versus general risk information, Outcome 3 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.

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Analysis 1.5

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

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Analysis 1.6

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

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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).

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Analysis 1.8

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

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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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.

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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.

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Analysis 1.14

Comparison 1 personalised risk communication versus general risk information, Outcome 14 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.

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Analysis 1.16

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

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Analysis 1.17

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

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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.

Analysis 1.18

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

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Analysis 1.19

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

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Analysis 1.20

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

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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.

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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.

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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.

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Analysis 3.2

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

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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).

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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.

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Analysis 3.5

Comparison 3 personalised risk communication versus general risk information for MAMMOGRAPHY, Outcome 5 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.

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Analysis 3.7

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

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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.

Analysis 3.8

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

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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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.

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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.

Analysis 5.8

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

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Analysis 6.1

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

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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.

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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.

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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).

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Analysis 6.5

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

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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).

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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.

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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.

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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.

Analysis 6.9

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

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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)	⊕⊕⊕⊕ high^2,3,4,7	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)	⊕⊕⊝⊝ low^5,6,7	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.

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

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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)	⊕⊕⊕⊝ moderate^1,14	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)	⊕⊕⊝⊝ low^2,11,14	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)	⊕⊕⊕⊕ high^3,14	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)	⊕⊕⊕⊕ high^4,6,13,14	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)	⊕⊕⊕⊕ high^{6, 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)	⊕⊕⊝⊝ low^7,8,13,14	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 low^5,8,9,14	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.

Summary of findings 2. Personalised risk communication versus general risk information for informed decision making about taking screening tests

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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]

Comparison 1. personalised risk communication versus general risk information

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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]

Comparison 2. personalised risk communication versus general risk information for PAP SMEARS

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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

Comparison 3. personalised risk communication versus general risk information for MAMMOGRAPHY

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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]

Comparison 4. personalised risk communication versus general risk information for CHOLESTEROL TESTS

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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

Comparison 5. personalised risk communication versus general risk information for 'HIGH RISK' PEOPLE

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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

Comparison 6. personalised risk communication versus general risk information for COLORECTAL SCREENING

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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]

Comparison 7. personalised risk communication versus general risk information for PROSTATE CANCER SCREENING

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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]

Comparison 8. Personalised risk communication versus general risk information for SKIN CANCER SCREENING

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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]

Comparison 9. Personalised risk communication versus general risk information for PRENATAL TESTING FOR FOETAL ABNORMALITY

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