The effectiveness of one-to-one risks-communication interventions in health care: A systematic review

Objectives. To assess whether risk-communication interventions are associat ed with changes in patient knowledge, attitudes, and behaviors, and to iden tify aspects of these interventions that modify these effects. Design. Syst ematic review. Data sources. 96 studies from the period 1985-1996 retrieved by electronic searching of eight databases, hand searching of four journal s, contacting key authors, and reference list searching. Main outcome measu res. The effect size of the principal outcome was identified from each stud y. Outcomes measuring behavioral change were preferred; if these were not a vailable, knowledge, anxiety, or risk perceptions were used, according to t he focus of the study. Data were available to calculate the principal effec t sizes for 82 of the studies. Analysis. Meta-regression. Results. The meth odologic qualities of the studies varied. Nevertheless, risk-communication interventions generally had positive (beneficial) effects. Interventions ad dressing treatment choices were associated with larger effects than were th ose in other contexts, such as prevention or screening. Interventions using individual risk estimates were associated with larger effects than were th ose using more general risk information. Two design variables were identifi ed as effect modifiers: randomized controlled trials were associated with s maller effects than other designs, and dichotomous outcomes were associated with larger effects than continuous outcomes. Conclusions. Risk communicat ion interventions may be most productive if they include individual risk es timates in the discussion between professional and patient. Patient decisio ns about treatment appear more amenable to change by these interventions th an attendance for screening or modification of risky behavior.