Visual feedback of individuals' medical imaging results for changing health behaviour

Abstract

Due to the limited nature of the available evidence and the mixed results that were found, no strong statements can be made about the effectiveness of communicating medical imaging results to change health behaviour. Only three trials in clinical populations were similar enough in term of setting, intervention and outcome to allow meta-analysis. We suggest, however, that targeted interventions using medical imaging technologies may be effective in certain contexts, or as applied to certain behaviours, but that this should be considered on an intervention by intervention basis, and not assumed as a general principle.

Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

“…These results are important in the context of substantial controversy about the role of screening for atherosclerosis. 19 Consistent with the results of atherosclerosis screening on smoking cessation, mainly derived from the RCT by Bovet et al, 11 a recent Cochrane review evaluated the impact of visual feedback of medical images in changing health behavior 41 and reported a statistically significant increase in smoking cessation behaviors (OR=2.81, 95% CI=1.23-6.41) after pooling the data from three studies. 11,16,42 Because of the exclusion of studies in patients with preexisting CVD, the present review did not include the study by Shahab et al 42 and did not pool data on smoking cessation behaviors because of clinical heterogeneity (different timing for assessment of smoking cessation behaviors, very few smokers in one RCT).…”

Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

“…These results are important in the context of substantial controversy about the role of screening for atherosclerosis. 19 Consistent with the results of atherosclerosis screening on smoking cessation, mainly derived from the RCT by Bovet et al, 11 a recent Cochrane review evaluated the impact of visual feedback of medical images in changing health behavior 41 and reported a statistically significant increase in smoking cessation behaviors (OR=2.81, 95% CI=1.23-6.41) after pooling the data from three studies. 11,16,42 Because of the exclusion of studies in patients with preexisting CVD, the present review did not include the study by Shahab et al 42 and did not pool data on smoking cessation behaviors because of clinical heterogeneity (different timing for assessment of smoking cessation behaviors, very few smokers in one RCT).…”

Can Communicating Personalised Disease Risk Promote Healthy Behaviour Change? A Systematic Review of Systematic Reviews

“…All nine systematic reviews included studies on smoking. Taken as a whole, the results provided some evidence of effects of communicating personalised disease on this behaviour, with some reviews suggesting effects on cessation at least in the short-term [ 24 , 25 , 27 ] but other reviews finding no such support [ 17 , 19 , 22 – 24 , 26 ]. There was no support for long-term smoking cessation in any review.…”

“…No language restriction, forward citation searching, published studies only, search strategy provided 5 trials (3 RCTs and 2 non-RCT, involving sequential allocation): 4 genetic testing only; 1 genetic testing + carbon monoxide testing 2304 Hackam (2012) [ 28 ] Non-invasive cardiovascular imaging (various methods) Behaviours (smoking [ n =4], diet [ n =1], physical activity [ n =1]) 11 databases searched (November 2010): including Cochrane, MEDLINE, EMBASE, Web of Science. Language restrictions unclear, forward citation searching, grey literature included, search strategy not provided 4 trials: 3 coronary calcification, 1 carotid atherosclerosis 709 Hollands (2010) [ 27 ] Feedback of medical imaging results (various methods) Health-related behaviours (smoking [ n =3], diet [=1], physical activity [ n =1]) to reduce risk (NB several studies excluded from present analyses as behaviours not relevant) 7 sources searched (September 2009): Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO, metaRegister of RCTs, ProQuest. Language restrictions unclear, forward citation searching, grey literature included, search strategy provided 4 trials (2 ultrasound, 2 computed tomography feedback) 684 Marteau (2010) [ 19 ] Communicating DNA-based risk estimates Health-related behaviours (smoking [ n =5], diet [=2], physical activity [ n =2]) 5 sources searched (April 2010): Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO.…”

“…Specifically, the majority of the reviews indicated that there was little, limited or no evidence of effects on the behaviours studied [ 17 , 19 , 22 – 24 ]. Other reviews did not comment on the effects on behaviour [ 22 ], indicated that there may be effects in the short-term but not long-term [ 25 ], that results were “mixed” [ 26 ] or that personalised risk information may be effective, but should be judged on an individual basis and not assumed as a general principle [ 27 ].…”

“… For smoking analysis, I 2 = 0 “We found limited evidence suggesting that noninvasive cardiovascular imaging alters primary prevention efforts.” Results imprecise – more research needed. Hollands (2010) [ 27 ] Imaging on smoking OR 2.81 (95%CI 1.23 to 6.41). Imaging on fibre consumption OR 0.36 (95%CI 0.08 to 1.53) Imaging on fat intake 1.84 (95%CI 0.51 to 6.71) Imaging on physical activity SMD 0.10 (95%CI -0.04 to 0.24) All trials had low risk of bias.…”

Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

“…These results are important in the context of substantial controversy about the role of screening for atherosclerosis. 19 Consistent with the results of atherosclerosis screening on smoking cessation, mainly derived from the RCT by Bovet et al, 11 a recent Cochrane review evaluated the impact of visual feedback of medical images in changing health behavior 41 and reported a statistically significant increase in smoking cessation behaviors (OR=2.81, 95% CI=1.23-6.41) after pooling the data from three studies. 11,16,42 Because of the exclusion of studies in patients with preexisting CVD, the present review did not include the study by Shahab et al 42 and did not pool data on smoking cessation behaviors because of clinical heterogeneity (different timing for assessment of smoking cessation behaviors, very few smokers in one RCT).…”

Can Communicating Personalised Disease Risk Promote Healthy Behaviour Change? A Systematic Review of Systematic Reviews

“…All nine systematic reviews included studies on smoking. Taken as a whole, the results provided some evidence of effects of communicating personalised disease on this behaviour, with some reviews suggesting effects on cessation at least in the short-term [ 24 , 25 , 27 ] but other reviews finding no such support [ 17 , 19 , 22 – 24 , 26 ]. There was no support for long-term smoking cessation in any review.…”

“…No language restriction, forward citation searching, published studies only, search strategy provided 5 trials (3 RCTs and 2 non-RCT, involving sequential allocation): 4 genetic testing only; 1 genetic testing + carbon monoxide testing 2304 Hackam (2012) [ 28 ] Non-invasive cardiovascular imaging (various methods) Behaviours (smoking [ n =4], diet [ n =1], physical activity [ n =1]) 11 databases searched (November 2010): including Cochrane, MEDLINE, EMBASE, Web of Science. Language restrictions unclear, forward citation searching, grey literature included, search strategy not provided 4 trials: 3 coronary calcification, 1 carotid atherosclerosis 709 Hollands (2010) [ 27 ] Feedback of medical imaging results (various methods) Health-related behaviours (smoking [ n =3], diet [=1], physical activity [ n =1]) to reduce risk (NB several studies excluded from present analyses as behaviours not relevant) 7 sources searched (September 2009): Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO, metaRegister of RCTs, ProQuest. Language restrictions unclear, forward citation searching, grey literature included, search strategy provided 4 trials (2 ultrasound, 2 computed tomography feedback) 684 Marteau (2010) [ 19 ] Communicating DNA-based risk estimates Health-related behaviours (smoking [ n =5], diet [=2], physical activity [ n =2]) 5 sources searched (April 2010): Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO.…”

“…Specifically, the majority of the reviews indicated that there was little, limited or no evidence of effects on the behaviours studied [ 17 , 19 , 22 – 24 ]. Other reviews did not comment on the effects on behaviour [ 22 ], indicated that there may be effects in the short-term but not long-term [ 25 ], that results were “mixed” [ 26 ] or that personalised risk information may be effective, but should be judged on an individual basis and not assumed as a general principle [ 27 ].…”

“… For smoking analysis, I 2 = 0 “We found limited evidence suggesting that noninvasive cardiovascular imaging alters primary prevention efforts.” Results imprecise – more research needed. Hollands (2010) [ 27 ] Imaging on smoking OR 2.81 (95%CI 1.23 to 6.41). Imaging on fibre consumption OR 0.36 (95%CI 0.08 to 1.53) Imaging on fat intake 1.84 (95%CI 0.51 to 6.71) Imaging on physical activity SMD 0.10 (95%CI -0.04 to 0.24) All trials had low risk of bias.…”

Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

“…These results are important in the context of substantial controversy about the role of screening for atherosclerosis. 19 Consistent with the results of atherosclerosis screening on smoking cessation, mainly derived from the RCT by Bovet et al, 11 a recent Cochrane review evaluated the impact of visual feedback of medical images in changing health behavior 41 and reported a statistically significant increase in smoking cessation behaviors (OR=2.81, 95% CI=1.23-6.41) after pooling the data from three studies. 11,16,42 Because of the exclusion of studies in patients with preexisting CVD, the present review did not include the study by Shahab et al 42 and did not pool data on smoking cessation behaviors because of clinical heterogeneity (different timing for assessment of smoking cessation behaviors, very few smokers in one RCT).…”

Can Communicating Personalised Disease Risk Promote Healthy Behaviour Change? A Systematic Review of Systematic Reviews

“…All nine systematic reviews included studies on smoking. Taken as a whole, the results provided some evidence of effects of communicating personalised disease on this behaviour, with some reviews suggesting effects on cessation at least in the short-term [ 24 , 25 , 27 ] but other reviews finding no such support [ 17 , 19 , 22 – 24 , 26 ]. There was no support for long-term smoking cessation in any review.…”

“…No language restriction, forward citation searching, published studies only, search strategy provided 5 trials (3 RCTs and 2 non-RCT, involving sequential allocation): 4 genetic testing only; 1 genetic testing + carbon monoxide testing 2304 Hackam (2012) [ 28 ] Non-invasive cardiovascular imaging (various methods) Behaviours (smoking [ n =4], diet [ n =1], physical activity [ n =1]) 11 databases searched (November 2010): including Cochrane, MEDLINE, EMBASE, Web of Science. Language restrictions unclear, forward citation searching, grey literature included, search strategy not provided 4 trials: 3 coronary calcification, 1 carotid atherosclerosis 709 Hollands (2010) [ 27 ] Feedback of medical imaging results (various methods) Health-related behaviours (smoking [ n =3], diet [=1], physical activity [ n =1]) to reduce risk (NB several studies excluded from present analyses as behaviours not relevant) 7 sources searched (September 2009): Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO, metaRegister of RCTs, ProQuest. Language restrictions unclear, forward citation searching, grey literature included, search strategy provided 4 trials (2 ultrasound, 2 computed tomography feedback) 684 Marteau (2010) [ 19 ] Communicating DNA-based risk estimates Health-related behaviours (smoking [ n =5], diet [=2], physical activity [ n =2]) 5 sources searched (April 2010): Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO.…”

“…Specifically, the majority of the reviews indicated that there was little, limited or no evidence of effects on the behaviours studied [ 17 , 19 , 22 – 24 ]. Other reviews did not comment on the effects on behaviour [ 22 ], indicated that there may be effects in the short-term but not long-term [ 25 ], that results were “mixed” [ 26 ] or that personalised risk information may be effective, but should be judged on an individual basis and not assumed as a general principle [ 27 ].…”

“… For smoking analysis, I 2 = 0 “We found limited evidence suggesting that noninvasive cardiovascular imaging alters primary prevention efforts.” Results imprecise – more research needed. Hollands (2010) [ 27 ] Imaging on smoking OR 2.81 (95%CI 1.23 to 6.41). Imaging on fibre consumption OR 0.36 (95%CI 0.08 to 1.53) Imaging on fat intake 1.84 (95%CI 0.51 to 6.71) Imaging on physical activity SMD 0.10 (95%CI -0.04 to 0.24) All trials had low risk of bias.…”