Improving subjective perception of personal cancer risk: systematic review and meta-analysis of educational interventions for people with cancer or at high risk of cancer

BACKGROUND: Newly diagnosed patients with
cancer require education about the disease, the
available treatments and potential consequences of
treatment. Greater understanding of cancer risk
has been found to be associated with greater
health-related quality of life, improved psychological
adjustment and greater health-related behaviours.
The aim of this systematic review was to
assess the effectiveness of educational interventions
in improving cancer risk perceptions, across all
types of interventions and cancers. METHOD: We
conducted a systematic review and meta-analysis of
randomised controlled trials (RCTs) and prospective
observational studies. Studies were identified
via Medline, PsycINFO, Allied and Complementary
Medicine (AMED), Cumulative Index to
Nursing and Allied Health Literature (CINAHL)
and Embase. A total of 206 articles were fully
reviewed by two reviewers to assess eligibility. We
included all studies that investigated the effect of
educational interventions on perceived risk of cancer,
reported personal cancer risk perception and
targeted people affected by cancer or people who
were at high or moderate risk of developing cancer.
RESULTS: 39 papers were included in the review.
Pooled results from RCTs (n = 11) showed that,
both in the short and long term, educational interventions
did not influence level (standardised mean
difference 0.05, 95% CI 0.24 to 0.34; p = 0.74) or
accuracy (odds ratio for improved risk accuracy
=1.96, 95% CI: 0.61 to 6.25; p = 0.26) of risk perception.
Only one RCT reported a short term difference
in risk ratings (p = 0.01). Of prospective
observational studies (n = 28), many did demonstrate
changes in level of perceived risk, and
improved risk accuracy and risk ratings in both the
short and long term. CONCLUSIONS: Despite
favourable results from prospective studies, there
was no clear evidence from RCTs to support the
effectiveness of educational interventions in
improving cancer risk perception. In addition many
challenges remain in improving cancer risk perception.
Many studies used one dimensional risk perception
measures (i.e. measuring magnitude or
frequency of risk, but not both). Cancer patients or
people at moderate or high risk of cancer often
overestimate their risk of developing cancer. Analyses
of predictors of change in risk perception indicated
that several variables such as baseline risk
perception, age, ethnicity, and cancer-related worry
were associated with changes in risk perception.
RESEARCH IMPLICATIONS: Further research
should focus on the development of new measures
for cancer risk perception and test whether a multidimensional
measure, combining different elements
of risk perception, is feasible and adequate. Integration
of demographic characteristics and psychosocial
factors into the design and implementation of
educational interventions, and well-designed educational
interventions using good quality, randomised
controlled trials are warranted. These future
research directions will help to clarify the effectiveness
of educational interventions for improving
cancer risk perception. CLINICAL IMPLICATIONS:
Based on the results of this review, we
would not recommend broad use in clinical practice
of educational interventions to improve cancer risk
perception. Despite favourable results from prospective
studies, there was no clear evidence from
RCTs to support their effectiveness.Systematic
review registration: PROSPERO register (Registration
number: CRD42012002861). ACKNOWLEDGEMENT
OF FUNDING: None.