Improving cancer risk understanding: a systematic review of educational interventions for people with, or at high risk of, cancer

Introduction: Understanding of cancer risk has been found to be theoretically
and empirically relevant in motivating cancer screening and risk reduction
behaviours. Risk perceptions have also been found to be associated
with health-related quality of life, including psychological stress, psychological
adjustment and health behaviours. Despite its importance, subjective
perceptions of personal cancer risk have been shown to be sometimes relatively
resistant to change.
Objective: To assess the effectiveness and quality of educational interventions
specifi cally developed to improve participants’ understanding of cancer
risk, we conducted a systematic review of published educational interventions
with a focus on risk perception.
Methods: Randomised and non-randomised trials and prospective studies
were identifi ed via Medline, PsycINFO, Embase, Amed and CINAHL databases
from 1806 to April 2012, and evaluated according to predetermined
criteria. A total of 2,701 articles were identifi ed after the removal of duplicates,
with 2,508 articles excluded after title and abstract screening by two
reviewers. A total of 181 articles were fully reviewed to assess eligibility.
The methodological quality of the included Studies was assessed using two
tools: the Quality Assessment Scoring for prospective studies and the
Cochrane collaboration tool for assessing risk of bias for randomised controlled
trial.
Results: A total of 35 studies met inclusion criteria, including six RCTs and
29 prospective studies. Most of the interventions (n = 20) examined risk
perceptions in the context of genetic counselling for breast, ovarian or
colorectal cancer. Most interventions reported only modest increases in the
accuracy of perceived risk. I will also present the strengths and weaknesses
of the interventions.
Conclusions: There are few interventions aiming to improve cancer risk
perception in cancers other than breast and ovarian. I will discuss the usefulness
of these educational interventions for different clinical and research
contexts, and the challenges for future research.