Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk

Wilson, Brenda J.; Torrance, Nicola; Mollison, Jill; Watson, Mags; Douglas, Alison; Miedzybrodzka, Z; Gordon, Richard; Wordsworth, Sarah; Campbell, Marion K; Haites, Neva Elizabeth; Grant, Adrian

doi:10.1093/fampra/cml026

Cited by 29 publications

(63 citation statements)

References 23 publications

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“…using the Cochrane Collaboration's tool for assessing risk of bias 21 (Table 2). [22][23][24][25][26][27][28][29][30][31] The heterogeneity of interventions and outcomes precluded any meta-analysis of the data. The review provides a narrative synthesis of the data.…”

Section: Study Appraisal and Synthesis Methodsmentioning

confidence: 99%

“…Women in the cervical screening trial had a greater understanding of screening guidelines and, in particular, screening intervals recommended for cervical screening as a result of the intervention. 32 Wilson et al 29 found no differences in patient knowledge between groups despite patient and clinician education.…”

Section: Patient Knowledgementioning

confidence: 98%

“…Of the 11 studies, 3 randomized by clinic and trialed a clinician-targeted intervention, 27,29,32 3 randomized by clinic and trialed a patient-targeted intervention, [24][25][26] and 5 randomized by patient and trialed a patient-targeted intervention. 22,23,28,30,31 One study randomized patients by clinic days to reduce potential contamination.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…27,29 In the GRAIDS trial, risk assessment increased the proportion of appropriate referrals when compared with local guidelines that were implemented with the GRAIDS tool. 29 Although there was an increase in appropriate referrals based on the local guidelines, the actual proportion of patients found to be at high risk was no different after more detailed assessment at the genetics clinic. This finding suggests a lack of specificity of the referral guideline that is likely to be implemented more systematically using a risk tool.…”

mentioning

confidence: 99%

“…For example, the relatively low recruitment rates in the US Family Healthware Impact trial probably were associated with response bias toward a well-educated sample with relatively high baseline rates of cancer screening. Additional methodologic weaknesses in some studies included small sample sizes and therefore potentially underpowered trials, 28,30,31 poor recruitment rates [22][23][24]26,[29][30][31] lack of clinician engagement in the intervention, 29 and patient-reported outcomes that may be influenced by social desirability bias. 28 The unit of randomization was not a clear source of heterogeneity despite greater risk of contamination in the patient-randomized trials.…”

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confidence: 99%

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Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

Walker

Licqurish

Chiang

et al. 2015

The Annals of Family Medicine

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PURPOSEWe conducted this review to identify published randomized controlled trials (RCTs) of cancer risk assessment tools used in primary care and to determine their impact on clinical utility (clinicians), screening uptake (patients), and psychosocial outcomes (patients). METHODSWe searched EMBASE, PubMed and the Cochrane databases for RCTs of cancer risk assessment tools in primary care up to May 2014. Only studies set in primary care, with patients eligible for screening, and English-language articles were included. RESULTSThe review included 11 trials of 7 risk tools. The trials were heterogeneous with respect to type of tool that was used, type(s) of cancer assessed, and outcomes measured. Evidence suggested risk tools improved patient risk perception, knowledge, and screening intentions, but not necessarily screening behavior. Overall, uptake of a tool was greater if initiated by patients, if used by a dedicated clinician, and when combined with decision support. There was no increase in cancer worry. Health promotion messages within the tool had positive effects on behavior change. Trials were limited by low-recruitment uptake, and the heterogeneity of the findings necessitated a narrative review rather than a meta-analysis.CONCLUSIONS Risk tools may increase intentions to have cancer screening, but additional interventions at the clinician or health system levels may be needed to increase risk-appropriate cancer screening behavior. INTRODUCTIONC ancer screening programs have been introduced in many countries for breast, 1 colorectal, 2 and cervical 3 cancer. With the growing recognition of the potential harms from population-based cancer screening programs, 4 risk-stratified screening is being proposed as a way of reducing harm and focusing on populations at higher risk of cancer. This concept can also be applied to primary preventive measures, especially as the evidence to support chemoprevention for common cancers such as breast and colorectal builds. 5,6 If risk-stratified cancer prevention is to be implemented, it requires risk assessment tools that can be used in primary care to identify those most likely to benefit from tailored prevention. 7 Cancer risk prediction models, based on epidemiologic data, calculate an individual's likelihood of developing cancer, identify an individual's risk of carrying a genetic mutation for a specific cancer (eg, BRCA 1 or BRCA 2), or both. 8,9 Newer risk models are beginning to incorporate genomic profiles and environmental exposures, 10 a trend that is likely to grow with the movement toward precision medicine.11 Risk assessment tools facilitate the translation of these risk models to estimate an individual's likelihood of developing different cancers by assessing the combination of risk factors including genetic, environmental 12,13 Primary care has an important role in the delivery of cancer screening programs and can increase screening uptake.18 Successful implementation of risk assessment tools into primary care is needed if risk-stratified cancer p...

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Section: Study Appraisal and Synthesis Methodsmentioning

confidence: 99%

Section: Patient Knowledgementioning

confidence: 98%

Section: Study Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

Walker

Licqurish

Chiang

et al. 2015

The Annals of Family Medicine

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Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

Arditi

Rège‐Walther

Durieux

et al. 2012

Cochrane Database of Systematic Reviews

119

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Background Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. Objectives To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). Search methods We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. Selection criteria We included individual-or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. Data collection and analysis Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach.

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Cancer genetic risk assessment for individuals at risk of familial breast cancer

Hilgart

Coles

Iredale

2012

Cochrane Database of Systematic Reviews

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This review found favourable outcomes for patients after risk assessment for familial breast cancer. However, there were too few papers to make any significant conclusions about how best to deliver cancer genetic risk-assessment services. Further research is needed assessing the best means of delivering cancer risk assessment, by different health professionals, in different ways and in alternative locations.

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Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk

Abstract: No convincing evidence of the effectiveness of the intervention was found, probably reflecting barriers to its use in routine practice.

Cited by 29 publications

References 23 publications

Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

Cancer genetic risk assessment for individuals at risk of familial breast cancer

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