Results of Trials of Cancer Risk Assessment Tools in Primary Care
| Outcomes Evaluated | Author, Year | Randomization Unit | Results |
|---|---|---|---|
| Patients | |||
| Risk perception | Wang et al26 2012 | Clinic | In patients who underestimated their CRC risk, the intervention increased accuracy of risk perception (intervention 17% vs control 10%, P = .05). There was no increase in accuracy of risk perception between groups in women who underestimated their risk for BC (intervention 18% vs control 14%, P = .4) or OC (intervention 8% vs control 13%, P = .4). |
| Emery et al27 2007 | Clinic | There was no difference in mean risk perception between patients referred from intervention vs control practices. Nonsignificant trend seen toward more accurate risk perception at the point of referral in intervention patients, with fewer overestimating their risk of cancer (OR = 1.50; 95% CI, 0.62–3.67; P = .36). | |
| Holloway et al32 2003 | Clinic | There was no change in risk perception of cervical cancer between groups (OR = 1.07; 95% CI, 0.85–1.35). | |
| Emmons et al30 Weinstein et al31 2004 | Patient | Accuracy of risk perception increased if risk was presented as combined relative and absolute risks or as absolute risk only vs control (for both people who overestimated and who underestimated their isk preintervention). | |
| Screening intentiona | Holloway et al32 2003 | Clinic | Women at intervention clinics were more likely to intend to reduce their screening interval for cervical screening in line with national guidelines (intervention 44% vs control 61%; OR = 0.51; 95% CI, 0.41–0.64; P <.001). |
| Schroy et al22 2011 | Patient | Mean intention scores to schedule a CRC screening test were higher for both intervention groups vs the control group: intervention group 1: DA (mean = 4.4; SD = 1.0); intervention group 2: DA+YDR (mean = 4.3; SD = 1.0); control group (mean = 3.9; SD = 1.4) (P <.001). Mean intention scores to complete a CRC screening test were higher for both intervention groups vs the control: intervention group 1: DA (mean = 4.3; SD = 1.0); intervention group 2: DA+YDR (mean = 4.3; SD = 1.0); control group (mean = 3.9; SD = 1.3) (P <.001). | |
| Schroy et al23 2012 | Patient | Booking a screening test: DA group was more likely to book a CRC screening test than control group at 1 month (69.1% vs 60.5%, P <.035); 3 months (71.8% vs 62.3%, P = .019); 6 months (77.0% vs 65.2%, P = .002); and 12 months (80.7% vs 71.4%, P = .011). DA group was more likely than DA+YDR group to book a CRC screening test at 1 month (69.1% vs 60.4%, P <.031); 6 months (77.0% vs 67.1%, P <.010); and 12 months (80.7% vs 73.6%, P = .048). | |
| Screening adherenceb | Rubinstein et al24 2011 | Clinic | CRC screening increased in both groups over time: intervention, from 76% to 84%, and control, from 77% to 84% (P = .95). BC screening increased in both groups over time: intervention, from 73% to 82%, and control, from 78% to 85% (P = .82). No difference between intervention and control groups in screening adherence for CRC, BC, or OC (P >.09) after 6 months. |
| Holloway et al32 2003 | Clinic | No difference in actual cervical screening intervals and consistency with guidelines between groups at 5 years: intervention 5%, control 7% (OR = 0.61; 95% CI, 0.36–1.03; P = .063). | |
| Schroy et al23 2012 | Patient | Completing a CRC screening test: DA group was more likely than control group to complete test (43.1% vs 4.8%, P = .046) | |
| Campbell et al28 1997 | Patient | No difference in cervical screening in women identified as being “underscreened” (P >.05). | |
| Behavior change | Ruffin et al25 2011 | Clinic | Intervention group was more likely than control group to increase daily fruit and vegetable intake from ≤5 servings to ≥5 servings (OR = 1.29; 95% CI, 1.05–1.58) and to increase physical activity to 5–6 times/week for ≥30 minutes per day (OR = 1.47; 95% CI, 1.08–1.98). |
| Anxiety/worry | Emery et al27 2007 | Clinic | Cancer worry was lower in patients referred from intervention practices vs from control practices: mean difference = −1.44 (95% CI, −2.64 to 0.23; P = .02). |
| Holloway et al32 2003 | Clinic | Women at intervention practices were less likely to be “fearful of cervical cancer” (OR = 0.66; 95% CI, 0.47–0.93; P = .019), “concerned about chances of serious problems with a smear in the future” (OR = 0.70; 95% CI, 0.51–0.95; P = .026), and “anxious about a recent smear test” (OR = 0.81; 95% CI, 0.66–0.98; P = .036). No differences seen between women at intervention vs control practices in “concern about their smear result” (OR = 0.75; 95% CI, 0.45–1.24; P = .25). | |
| Emmons et al30 Weinstein et al31 2004 | Patient | 33% of all participants in the study had less cancer worry and 17% had more cancer worry after using the Harvard CRC Risk Tool (comparative data between groups not reported). | |
| Knowledge | Emery et al27 2007 | Clinic | There was a nonsignificant increase in cancer knowledge in patients referred from intervention practices vs from control practices: BC knowledge mean difference = 0.11 (95% CI, −1.05 to 1.27) and CRC knowledge mean difference = 0.64 (95% CI, −1.01 to 2.29). |
| Wilson et al29 2006 | Clinic | No difference seen in patient knowledge between groups for items “Stress is a major cause of BC” (23% vs 23%, P = .98); “Having one close relative with BC always increases your risk considerably” (88% vs 91%, P = .71); and “Minor injury to the breast can cause BC” (20% vs 23%, P = .78). | |
| Holloway et al32 2003 | Clinic | 85% of women at control practices incorrectly agreed that “cervical cancer is among the top 4 female cancers in the UK” compared with 22% of women at intervention practices (OR = 0.05; 95% CI, 0.02–0.11; P <.0001). | |
| Schroy et al22 2011 | Patient | DA groups and DA+YDR group both had increased knowledge scores vs control: intervention group 1 (DA): mean = 3.2; SD = 2.6; intervention group 2 (DA+YDR): mean = 3.0; SD = 2.5; control: mean = 0.8; SD = 2.2 (P <.001). No differences seen in knowledge scores between DA and DA+YDR groups. | |
| Satisfaction | Schroy et al22 2011 | Patient satisfaction was higher for DA or DA+YDR vs control: intervention group 1 (DA): mean = 50.7; SD = 6.2; intervention group 2 (DA+YDR): mean = 50.5; SD = 6.2; control group: mean = 46.7; SD = 7.9 (P <.001). Satisfaction did not differ between DA and DA+YDR groups. | |
| Clinicians | |||
| Appropriate screening and/or referral | Emery et al27 2007 | Clinic | Increase seen in referral rate to cancer genetics clinic in intervention practices; mean difference = 3.0 referrals per 10,000 patients per practice per year (95% CI, 1.2–4.8; P = .002). Referrals from intervention practices were more likely to be consistent with referral guidelines and therefore “appropriate” vs control practice referrals (OR = 5.2; 95% CI, 1.7–15.8; P = .006). |
| Wilson et al29 2006 | Clinic | No difference seen between groups in appropriateness of referrals: intervention 58%, control 48% (RR = 1.18; 95% CI, 0.88–1.37). | |
| Clinician confidence | Emery et al27 2007 | Clinic | Clinicians’ confidence in managing people with a family history of cancer increased in intervention practices vs control practices (P <.0001). |
| Wilson et al29 2006 | Clinic | No change seen in clinician confidence between groups for the following about BC risk: “taking appropriate family history” (60% vs 61%, P = .93); “knowing which patients need to be referred” (40% vs 33%, P = .27); “reassuring low-risk patients” (57% vs 52%, P = .46); and “being able to answer questions” (23% vs 22%, P = .77). |