What is the impact of personalized risk communication on patient decision making about screening tests?
Patients presented with personalized risk information are more likely to make informed decisions about screening than patients who are presented with generic risk information. Individualizing risk appears to improve the accuracy of patients' risk perception and decrease anxiety.
Screening tests are not appropriate for every patient. Instead, individual risk and personal values play a role in determining whether a given patient should undergo screening for a disease. Many guidelines recommend that physicians have a discussion with patients when determining whether to perform a specific screening test, and many guidelines use individual risk as a differentiator for recommendations. For instance, the U.S. Preventive Services Task Force recommends that physicians discuss a patient's risks and values before making a decision about screening for breast cancer.1 Ideal risk communication would increase a patient's knowledge about his or her own risk of a given condition and lead to a well-informed decision to undergo or decline screening for that condition.
This review included 41 studies with a total of 28,700 participants. Three studies evaluated patients' ability to make informed choices with and without individualized risk information. All three of the studies used the Multidimensional Measure of Informed Choice, a tool that assesses consistency between a patient's knowledge, attitudes, and choices about a screening test.2 Combined, 45% of those receiving personalized risk communication made informed choices, compared with 20% of those receiving generic risk communication. Pooled analysis showed strong evidence that personalized risk communication was associated with increased informed decision making (odds ratio [OR] = 3.65; 95% confidence interval [CI], 2.13 to 6.23).
Pooled analysis of nine studies showed improved knowledge levels about screening tests in patients who received personalized risk communication. Similarly, three studies evaluating risk perception showed a trend toward improved risk perception with personalized risk communication (OR = 1.65; 95% CI, 0.96 to 2.81). Personalized risk communication resulted in an increase in the uptake of screening tests (OR = 1.15; 95% CI, 1.02 to 1.29). In the one study that looked at “appropriate uptake” of cholesterol screening, personalized risk communication resulted in higher levels of appropriate uptake (OR = 1.32; 95% CI, 1.14 to 1.55).3
Several facts need to be considered when assessing these findings. First, the effects of personalized risk communication on uptake of screening seemed to be greater for participants told they were at higher risk. This could mean that a patient being told that he or she is at high risk is the main effect, rather than the personalized communication of risk. Second, these results were dominated by studies addressing mammography and colorectal cancer screening (34 out of 41 studies), which limits their generalizability to other screening tests. Lastly, to date, there are relatively few conditions for which personalized risk can be accurately calculated quickly and easily. This further calls into question the implications of these findings and highlights the need for continued research to generate clinical risk calculation tools.
Physicians who counsel patients about screening options should help them understand the impact of disease screening in the context of each patient's individual risk. When available, risk calculators that provide individualized risk assessments should be used. The results of this review suggest that this will improve knowledge and informed decision making.