The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis
French, David P
Prevost, A Toby
BMJ Publishing Group
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Hollands, G., French, D. P., Griffin, S., Prevost, A. T., Sutton, S., King, S., & Marteau, T. (2016). The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ, 352 (i1102)https://doi.org/10.1136/bmj.i1102
Background: DNA-based disease risk information is becoming widely available. Expectations are high that communicating this information motivates behaviour change to reduce risk. Objective: To assess the impact of communicating DNA-based disease risk estimates on risk-reducing health behaviours and motivation to engage in such behaviours. Design: Systematic review with meta-analysis, using Cochrane methods. We assessed risk of bias for each included study and quality of evidence for each behavioural outcome. Data sources: We searched the following databases up to 25th February 2015: MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials. We also conducted backward and forward citation searches. Eligibility criteria for selecting studies: Randomised and quasi-randomised controlled trials involving adults in which one group received personalised DNA-based disease risk estimates for diseases for which the risk could be reduced by behaviour change. Eligible studies included a measure of risk-reducing behaviour. Results: We examined 10,515 abstracts and included 18 studies, which reported on seven behavioural outcomes, including smoking cessation (six studies; n = 2663); diet (seven studies; n = 1784), and physical activity (six studies; n = 1704). Meta-analysis revealed no statistically significant effects of communicating DNA-based risk estimates on smoking cessation (odds ratio 0.92, 95% confidence interval 0.63 to 1.35, p = 0.67), diet (standardised mean difference 0.12, 95% confidence interval -0.00 to 0.24, p = 0.05) or physical activity (standardised mean difference -0.03, 95% confidence interval -0.13 to 0.08, p=0.62). There were also no effects on any other behaviours (alcohol use, medication use, sun protection behaviours, and attendance at screening or behavioural support programmes), on motivation to change behaviour, and no adverse effects, including depression and anxiety. Subgroup analyses provided no clear evidence that communication of a risk-conferring genotype impacted on behaviour more than did communication of the absence of such a genotype. However, studies were predominantly at high or unclear risk of bias and evidence was typically of low quality. Conclusions: Expectations that communicating DNA-based risk estimates changes behaviour are not supported by existing evidence. These results do not support use of genetic testing or the search for risk-conferring gene variants for common complex diseases on the basis that they motivate risk-reducing behaviour. Systematic review registration: This is a revised and updated version of a Cochrane review from 2010 adding 11 studies to the seven previously identified.
genetic testing, risk communication, personalised medicine, systematic review, health behaviour
A previous version of this review was funded as part of a grant from the Medical Research Council, UK (Risk communication in preventive medicine: optimising the impact of DNA risk information; G0500274). Updating this review was funded by an NIHR Senior Investigator award to TMM. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Medical Research Council (MC_U106179474)
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External DOI: https://doi.org/10.1136/bmj.i1102
This record's URL: https://www.repository.cam.ac.uk/handle/1810/253826