Messages Influencing College Women's Tanning Bed Use: Statistical versus Narrative Evidence Format and a Self-Assessment to Increase Perceived Susceptibility Impact of a multimedia intervention "Skinsafe" on patients' knowledge and protective behaviors. Cluster-randomised trial of risk communication to enhance informed uptake of cervical screening. Women's knowledge and beliefs regarding breast cancer Gail Model Risk Assessment and Risk Perceptions Electronic patient messages to promote colorectal cancer screening: a randomized controlled trial. Clinical utility of family history for cancer screening and referral in primary care: A report from the Family Healthware Impact Trial The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care Aid-assisted decision making and colorectal cancer screening: a randomized controlled trial. Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions. Effects of Communicating Social Comparison Information on Risk Perceptions for Colorectal Cancer Development and reliability of a brief skin cancer risk assessment tool. Utilizing Lung Cancer Risk Prediction Models to Promote Smoking Cessation: Two Randomized Controlled Trials Decision-Making Processes for Breast, Colorectal, and Prostate Cancer Screening: The DECISIONS Survey Mammography screening after risk-tailored messages: the women improving screening through education and risk assessment (WISER) randomized, controlled trial. Harvard Report on Cancer Prevention Volume 4: Harvard Cancer Risk Index Effects of Breast Cancer Risk Counseling for Sexual Minority Women Prospective evaluation of a risk scoring system for cervical neoplasia in primary care. Results of a randomized study of telephone versus in-person breast cancer risk counseling. Effects of a Mail and Telephone Intervention on Breast Health Behaviors The Impact of a Novel Computer-Based Decision Aid on Shared Decision Making for Colorectal Cancer Screening Overestimation of risk ratios by odds ratios in trials and cohort studies: alternatives to logistic regression Increasing the accuracy of perceived breast cancer risk: results from a randomized trial with Cancer Information Service callers. Effects of a mammography decision-making intervention at 12 and 24 months. Randomized Trial of Tailored Skin Cancer Prevention for Children: The Project SCAPE Family Study
Underst and ing the effect of messages and other influences on health decision-making has the potential to decrease risky behavior such as tanning bed use . This study explores the effect of type of evidence , self- assessment s of risk for skin cancer , and personality factors on intention to use and use of tanning beds among Caucasian female college students . Specifically , it targeted the perceived susceptibility component of the Health Belief Model and its impact on intention to tan as well as changes in actual tanning behavior . College students ( N=141 ) in the southeast United States read r and omly assigned messages and self- assessment s , filled out surveys , and were later contacted for a follow-up telephone survey . The statistical message was rated higher on information value and also result ed in decreased intention to tan , decreased tanning behavior , and increased perceived susceptibility to skin cancer . The narrative message , in contrast , increased perceptions of realism and also worked to decrease intentions to tan . Additionally , the self- assessment manipulation result ed in increased susceptibility and decreased intention to tan and post tanning behavior . Personality factors explained small portions of variance . Key limitations and directions for future research are also addressed BACKGROUND Rates of malignant melanoma are rising , with those people with sun-sensitive skin most at risk . Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn . This study aim ed to evaluate the impact of an interactive multimedia intervention " Skinsafe " on patients ' knowledge about melanoma and on their skin protective behaviors . METHODS In this cluster-r and omized , controlled trial conducted in Nottinghamshire , UK , doctors and nurses in 5 family practice s prescribed Skinsafe to patients with higher risk skin characteristics .  Measures of melanoma knowledge , perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practice s. RESULTS AND DISCUSSION Participants had low levels of melanoma knowledge at baseline . At follow-up , the intervention group had higher knowledge scores than control ( 3.71 vs. 3.03 , P < or = 0.001 ) , reported more protective skin behaviors ( 5.36 vs. 5.06 , P = 0.007 ) and were more likely to report mole checking ( odds ratio 1.67 , 95 % CI 1.04 to 2.70 , P = 0.035 ) . The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical setting BACKGROUND Women overestimate both population and individual risk of cervical cancer . This may contribute to the recognised excess screening frequency for low-risk women . AIM To investigate whether an individualized risk communication package could affect stated preferences for screening interval and actual screening behaviour . DESIGN Pragmatic , practice -based cluster r and omised controlled trial . SETTING Twenty-nine practice s ( 15 intervention , 14 control ) in North Wales recruited 1890 women attending for cervical smears . METHOD A risk communication package containing visual material was compared with normal practice . Practice nurses received training in its delivery . The short-term primary outcome was stated preference for screening interval ; the long-term primary outcome was actual screening behaviour . RESULTS In the short term , intervention arm women were significantly less likely to prefer a shorter than recommended interval ( odds ratio [ OR ] = 0.51 , 95 % confidence interval [ CI ] = 0.41 to 0.64 ; P < 0.0001 ) . At the five-year follow-up , fewer women in the intervention arm had attended for screening sooner than their recommended recall . The magnitude of difference in excess screening interval preference and behaviour was similar , but behaviour had a wider confidence interval and a marginally non-significant P-value ( OR = 0.61 , 95 % CI = 0.36 to 1.03 ; P = 0.063 ) . Better knowledge and more accurate risk perceptions were demonstrated , with an improvement in measures of anxiety . The extra cost per woman receiving the intervention was 6 Pounds . CONCLUSIONS Women 's perception of risk contributes to determining screening intervals in addition to practice factors . Simple risk information delivered in primary care affected women 's stated preferences for tests . The impact on actual screening behaviour was more equivocal . Overall , the intervention showed a substantial benefit and any disbenefit can be ruled out . This approach to providing risk information could , at low cost , benefit other screening programmes and may relieve anxiety Approximately 20–30 % of women delay for 12 weeks or more from self-discovery of a breast symptom to presentation to a health care provider , and such delay intervals are associated with poorer survival . Underst and ing the factors that influence patient delay is important for the development of an effective , targeted health intervention programme to shorten patient delay . The aim of the study was to elicit knowledge and beliefs about breast cancer among a sample of the general female population , and examine age and socio-economic variations in responses . Participants were r and omly selected through the Postal Address File , and data were collected through the Office of National Statistics . Geographically distributed throughout the UK , 996 women participated in a short structured interview  to elicit their knowledge of breast cancer risk , breast cancer symptoms , and their perceptions of the management and outcomes associated with breast cancer . Women had limited knowledge of their relative risk of developing breast cancer , of associated risk factors and of the diversity of potential breast cancer-related symptoms . Older women were particularly poor at identifying symptoms of breast cancer , risk factors associated with breast cancer and their personal risk of developing the disease . Poorer knowledge of symptoms and risks among older women may help to explain the strong association between older age and delay in help-seeking . If these findings are confirmed they suggest that any intervention programme should target older women in particular , given that advancing age is a risk factor for both developing breast cancer and for subsequent delayed presentation Patients can benefit from accessible breast cancer risk information . The Gail model is a well-known means of providing risk information to patients and for guiding clinical decisions . Risk presentation often includes 5-year and lifetime percent chances for a woman to develop breast cancer . How do women perceive their risks after Gail model risk assessment ? This exploratory study used a r and omized clinical trial design to address this question among women not previously selected for breast cancer risk . Results suggest a brief  risk assessment intervention  changes quantitative and comparative risk perceptions and improves accuracy . This study improves our underst and ing of risk perceptions by evaluating an intervention in a population not previously selected for high-risk status and measuring perceptions in a variety of formats BACKGROUND Colorectal cancer is a leading cause of cancer mortality , yet effective screening tests are often underused . Electronic patient messages and personalized risk assessment s delivered via an electronic personal health record could increase screening rates . METHODS We conducted a r and omized controlled trial in 14 ambulatory health centers involving 1103 patients ranging in age from 50 to 75 years with an active electronic personal health record who were overdue for colorectal cancer screening . Patients were r and omly assigned to receive a single electronic message highlighting overdue screening status with a link to a Web-based tool to assess their personal risk of colorectal cancer .  The outcomes included colorectal cancer screening rates at 1 and 4 months . RESULTS Screening rates were higher at 1 month for patients who received electronic messages than for those who did not ( 8.3 % vs 0.2 % , P < .001 ) , but this difference was no longer significant at 4 months ( 15.8 % vs 13.1 % , P = .18 ) . Of 552 patients r and omized to receive the intervention , 296 ( 54 % ) viewed the message , and 47 ( 9 % ) used the Web-based risk assessment tool . Among 296 intervention patients who viewed the electronic message , risk tool users were more likely than nonusers to request screening examinations ( 17 % vs 4 % , P = .04 ) and to be screened ( 30 % vs 15 % , P = .06 ) . One-fifth of patients ( 19 % ) using the risk assessment tool were estimated to have an above-average risk for colorectal cancer . CONCLUSION Electronic messages to patients produce an initial increase in colorectal cancer screening rates , but this effect is not sustained over time . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01032746 Purpose : To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change . Methods : We conducted a r and omized clinical trial in primary care patients aged 35–65 years using Family Healthware  , a self-administered , internet-based tool that collects family history for six common diseases including breast cancer , colon cancer , and ovarian cancer , stratifies risk into three tiers , and provides tailored prevention messages .  Cancer screening adherence and consultation were measured at baseline and 6-month follow-up . Results : Of 3283 participants , 34 % were at strong or moderate risk of at least one of the cancers . Family Healthware identified additional participants for whom earlier screening ( colon cancer , 4.4 % ; breast cancer , women ages : 35–39 years , 9 % ) or genetic assessment ( colon cancer , 2.5 % ; breast cancer , 10 % ; and ovarian cancer , 4 % ) may be indicated . Fewer than half were already adherent with risk-based screening . Screening adherence improved for all risk categories with no difference between intervention and control groups . Consultation with specialists did not differ between groups . Conclusion : Family Healthware identified patients for intensified cancer prevention . Engagement of clinicians and patients , integration with clinical decision support , and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment The objective was to evaluate the effect of an assessment strategy using the computer decision support system ( the GRAIDS software ) , on the management of familial cancer risk in British general practice in comparison with best current practice . The design included cluster r and omised controlled trial , and involved forty-five general practice teams in East Anglia , UK . R and omised to GRAIDS ( Genetic Risk Assessment on the Internet with Decision Support ) support ( intervention n=23 ) or comparison ( n=22 ) . Training in the new assessment strategy and access to the GRAIDS software ( GRAIDS arm ) was conducted , compared with an educational session and guidelines about managing familial breast and colorectal cancer risk ( comparison ) were mailed . Outcomes were measured at practice , practitioner and patient levels . The primary outcome measure , at practice level , was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines . Other measures included practitioner confidence in managing familial cancer ( GRAIDS arm only ) and , in patients : cancer worry , risk perception and knowledge about familial cancer . There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practice s ( mean 6.2 and 3.2 referrals per 10 000 registered patients per year ; mean difference 3.0 referrals ; 95 % confidence interval ( CI ) 1.2–4.8 ; P=0.001 ) ; referrals from GRAIDS practice s were more likely to be consistent with referral guidelines ( odds ratio (OR)=5.2 ; 95 % CI 1.7–15.8 , P=0.006 ) . Patients referred from GRAIDS practice s had lower cancer worry scores at the point of referral ( mean difference −1.44 95 % CI −2.64 to −0.23 , P=0.02 ) . There were no differences in patient knowledge about familial cancer . The intervention increased GPs ' confidence in managing familial cancer . Compared with education and mailed guidelines , assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk , improved practitioner confidence and had no adverse psychological effects in patients . Trials are registered under N0181144343 in the UK National Research Register BACKGROUND Shared decision making ( SDM ) is a widely recommended yet unproven strategy for increasing colorectal cancer ( CRC ) screening uptake . Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results . PURPOSE To assess the impact of decision aid-assisted SDM on CRC screening uptake . DESIGN RCT . SETTING / PARTICIPANTS The study was conducted at an urban , academic safety-net hospital and community health center between 2005 and 2010 . Participants were asymptomatic , average-risk patients aged 50 - 75 years due for CRC screening . INTERVENTION Study participants ( n=825 ) were r and omized to one of two intervention arms ( decision aid plus personalized risk assessment or decision aid alone ) or control arm . The interventions took place just prior to a routine office visit with their primary care providers . MAIN OUTCOME MEASURES The primary outcome was completion of a CRC screening test within 12 months of the study visit . Logistic regression was used to identify predictors of test completion and mediators of the intervention effect . Analysis was completed in 2011 . RESULTS Patients in the decision-aid group were more likely to complete a screening test than control patients ( 43.1 % vs 34.8 % , p=0.046 ) within 12 months of the study visit ; conversely , test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar ( 43.1 % vs 37.1 % , p=0.15 ) . Assignment to the decision-aid arm ( AOR=1.48 , 95 % CI=1.04 , 2.10 ) , black race ( AOR=1.52 , 95 % CI=1.12 , 2.06 ) and a preference for a patient-dominant decision-making approach ( AOR=1.55 , 95 % CI=1.02 , 2.35 ) were independent determinants of test completion . Activation of the screening discussion and enhanced screening intentions mediated the intervention effect . CONCLUSIONS Decision aid-assisted SDM has a modest impact on CRC screening uptake . A decision aid plus personalized risk assessment tool is no more effective than a decision aid alone . TRIAL REGISTRATION This study is registered at www . clinical trials.govNCT00251862 OBJECTIVE This experiment tested the effects of an individualized risk-based online mammography decision intervention . The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions . METHODS 2918 women ages 35 - 49 were stratified into two levels of 10-year breast cancer risk ( < 1.5 % ; ≥1.5 % ) then r and omly assigned to one of eight conditions : two comparison conditions and six risk-based intervention conditions that varied according to a 2 ( amount of content : brief vs. extended ) x 3 ( format : expository vs. untailored exemplar [ example case ] vs. tailored exemplar ) design . Outcomes included mammography intentions and accuracy of perceived breast cancer risk . RESULTS Risk-based intervention conditions improved the match between objective risk estimates and perceived risk , especially for high-numeracy women with a 10-year breast cancer risk ≤1.5 % . For women with a risk≤1.5 % , exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen . CONCLUSION A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions . PRACTICE IMPLICATION S Interventions could be applied in online or clinical setting s to help women underst and risk and make mammography decisions People typically believe their health risks are lower than those of others ( i.e. , optimistic bias ) . We sought to increase perceptions of colorectal cancer ( CRC ) risk among adults aged 50–75 who were nonadherent to fecal occult screening ( FOBT ) . 160 participants were r and omized to receive information about the following : ( 1 ) general CRC risk factors ( control ) , ( 2 ) general and tailored CRC risk factor feedback ( absolute risk group ) , or ( 3 ) absolute CRC risk factor feedback plus CRC feedback as to how their total number of risk factors compared with that of others ( absolute plus comparative risk group ) . Primary outcomes were perceived absolute and comparative risks , attitudinal ambivalence toward FOBT , and screening intentions ; the secondary outcome was return of a completed FOBT . Participants who were told that they had more than the average number of risk factors believed their comparative CRC risk was higher than that of controls and of participants informed that they did not have more than the average number of risk factors . Perceived absolute risk did not vary by group . Participants who received social comparison risk factor feedback expressed greater intentions to screen via a FOBT than participants who received absolute risk feedback and controls ; they also expressed less ambivalence about FOBT screening than controls . Although not statistically significant , participants informed they were at lower comparative risk had the highest proportion of completing an FOBT than any other group . These results suggest that providing social comparison CRC risk factor feedback can effectively reduce optimistic comparative risk perceptions . Contrary to findings of models of health behavior change , being informed that one does not have more than the average number of CRC risk factors , while result ing in lower evaluations of perceived comparative risk , did not result in higher ambivalence toward and lower intentions to screen using FOBT or the lowest rate of screening This study aim ed to develop and pilot test a brief  skin cancer risk assessment tool ( BRAT ) , a self-administered instrument that can be reliably used to assess skin cancer risk . To develop the BRAT , we critically review ed published literature on risk factors ; formulated a draft question naire ; pilot tested the question naire ; and retested 1 month later . The BRAT items address the key risk factors for melanoma and other keratinocyte skin cancers : ethnicity , personal and family history of skin cancer , mole count , freckles , childhood residence , sunburn history , and sun sensitivity factors ( skin color , natural hair color , ease of sunburning and tanning ) .  One hundred sixty-five persons completed the initial BRAT pilot study , and 52 additional people at moderate- or high-risk completed a second BRAT pilot study .  Results were as follows : using a dichotomous risk measure , about 90 % of subjects would be correctly classified at baseline and follow-up . Weighted kappa for the total BRAT score ( 0.41 - 0.68 ) and for individual items ( 0.57 - 0.99 ) were fair to good , as were correlation coefficients . The BRAT has acceptable to good reproducibility . Reliability statistics compared favorably with those reported in the literature for similar measures Purpose : The current project sought to examine whether delivery of lung cancer risk projections ( calculated using the Liverpool Lung Project [ LLP ] risk model ) predicted follow-up smoking status . Design : Two single-blinded r and omized controlled trials . Setting : Stop Smoking Services in Liverpool ( United Kingdom ) . Participants : Baseline current smokers ( N = 297 ) and baseline recent former smokers ( N = 216 ) were recruited . Intervention : Participants allocated to intervention groups were provided with personalized lung cancer risk projections , calculated using the LLP risk model . Measures : Baseline and follow-up question naires explored sociodemographics , smoking behavior , and lung cancer risk perceptions . Analysis : Bivariate analyses identified significant differences between r and omization groups , and logistic regression models were developed to investigate the intervention effect on the outcome variables . Results : Lung cancer risk projections were not found to predict follow-up smoking status in the trial of baseline current smokers ; however , they did predict follow-up smoking status in the trial of baseline recent former smokers ( odds ratio : 1.91 ; 95 % confidence interval : 1.03 - 3.55 ) . Conclusion : The current study suggests that lung cancer risk projections may help maintain abstinence among individuals who have quit smoking , but the results did not provide evidence to suggest that lung cancer risk projections motivate current smokers to quit Background Patients should underst and the risks and benefits of cancer screening in order to make informed screening decisions . Objectives To evaluate the extent of informed decision making in patient-provider discussion s for colorectal ( CRC ) , breast ( BrCa ) , and prostate ( PCa ) cancer screening . Setting National sample of US adults identified by r and om-digit dialing . Design Cross-sectional survey conducted between November 2006 and May 2007 . Participants English-speaking US adults aged 50 y and older who had discussed cancer screening with a health care provider within the previous 2 y. Measurements Cancer screening survey modules that asked about demographic characteristics , cancer knowledge , the importance of various sources of information , and self-reported cancer screening decision-making processes .  Results Overall , 1082 participants completed 1 or more of the 3 cancer modules . Although participants generally considered themselves well informed about screening tests , half or more could not correctly answer even 1 open-ended knowledge question for any given module . Participants consistently overestimated risks for being diagnosed with and dying from each cancer and overestimated the positive predictive values of prostate-specific antigen tests and mammography . Providers were the most highly rated information source , usually initiated screening discussion s ( 64%–84 % ) , and often recommended screening ( 73%–90 % ) . However , participants reported that providers elicited their screening preferences in only 31 % ( CRC women ) to 57 % ( PCa ) of discussion s. Although more than 90 % of the discussion s addressed the pros of screening , only 19 % ( BrCa ) to 30 % ( PCa ) addressed the cons of screening . Limitations Recall bias is possible because screening process reports were not independently vali date d. Conclusions Cancer screening decisions reported by patients who discussed screening with their health care providers consistently failed to meet criteria for being informed . Given the high ratings for provider information and frequent recommendations for screening , providers have important opportunities to ensure that informed decision making occurs for cancer screening decisions AIMS A r and omized trial investigated the impact of risk-tailored messages on mammography in diverse women in the Virginia Commonwealth University Health System 's gynecology clinics . METHODS From 2003 to 2005 , 899 patients > or = 40 years of age were r and omized to receive risk-tailored information or general information about breast health . Multiple logistic regression analyses summarize their breast health practice s at 18 months . RESULTS At baseline , 576 ( 64 % ) women reported having a mammogram in the past year . At 18-month follow-up , mammography rates were 72.6 % in the intervention group and 74.2 % in the control group ( N.S. ) . Women ( n = 123 ) who reported worrying about breast cancer " often " or " all the time " had significantly higher mammography rates with the intervention ( 85.0 % ) vs. the controls ( 63.5 % ) . No significant differences existed in clinical breast examination , self-examination , or mammography intentions between the two study arms . However , intervention women with lower education reported significantly fewer clinical breast examinations at follow-up . CONCLUSIONS The brief intervention with a risk-tailored message did not have a significant effect overall on screening at 18 months . However , among those who worried , mammography rates in the intervention group were higher . Individual characteristics , such as worry about breast cancer and education status , may impact interventions to improve breast cancer prevention practice Abstract Objective : Prediction of cancer risk is a minor component of current health risk appraisal s. Perception of individual cancer risk is poor . A Cancer Risk Index was developed to predict individual cancer risk  for cancers accounting for 80 % of the cancer burden in the United States . Methods : We used group consensus among research ers at the Harvard Medical School and Harvard School of Public Health to identify risk factors as definite , probable and possible causes of cancer . Risk points were allocated according to the strength of the causal association and summed . Population average risk of cancer and cumulative 10-year risk was obtained from SEER data . Individual ranking relative to the population average was determined . The risk index was evaluated for validity using colon cancer incidence in prospect i ve cohort data . Results : The Harvard Cancer Risk Index provides a broad classification of cancer risk . Validation against cohort data shows good agreement for colon cancer . Conclusion : The Harvard Cancer Risk Index offers a simple estimation of personal risk of cancer . It may help inform users of the major risk factors for cancer and identify changes in lifestyle that will reduce their risk . It offers the potential for tailored health-promotion messages Sexual minority women ( lesbian and bisexual ) represent a vulnerable group regarding their breast health . The participants in this study were 150 women aged 18–74 recruited via public announcements in mainstream and sexual minority communities in the greater Seattle metropolitan area . Potential participants were recruited to participate in a r and omized trial of a breast cancer risk counseling intervention for sexual minority women . The counseling intervention produced significant reductions in perceived risk of breast cancer , anxieties and fears about breast cancer at 6 and 24 months , and increases in breast screening rates at 24 months in the intervention arm , compared with the control arm participants . These data add to the growing body of knowledge on sexual minority women 's health and point to areas of community action and future research BACKGROUND Against a background of concern over the costs of the cervical screening programme in the United Kingdom , increased precision in targeting groups at high risk of having an abnormal cervical smear offers a means of increasing efficiency . Previous papers have described the development of a risk scoring system and its feasibility and reliability in primary care . AIM A study was carried out to assess the validity of the scoring system by testing its predictive ability on a prospect i ve data set . METHOD Consecutive attenders for cervical smear tests at seven practice s and three clinics were recruited for the study . The women completed a question naire from which their  risk scores  could be calculated . The scores were compared with cytology and histology results . Various performance statistics were obtained . RESULTS In terms of cervical intraepithelial neoplasia ( CIN ) 2 or 3 , there was an 11 fold increased risk among the low risk group ( scores of four or five ) compared with the very low risk group ( scores of three or less ) . The system enabled the identification of 75 % ( 95 % confidence interval 62 % to 84 % ) of cases of CIN 2 or 3 among the 21 % of the 3629 women with known histology who had a score of four or five . CONCLUSION Given the ease with which risk status can be ascertained ( a risk score could not be calculated for only 23 of 3661 women ) and the magnitude of difference in risk , the risk scoring system appears to have potential for assisting the targeting of screening re sources . Studies of risk perception and behaviour , and ultimately a r and omized controlled trial , are required to assess the effectiveness and cost effectiveness of risk targeting OBJECTIVE Women of all risk levels have reported high interest in obtaining genetic testing for breast cancer risk . Breast cancer risk counseling may help women to learn about their risk and appropriate options of testing . This study measured the effects of an intervention in-person and by telephone , compared to a control group . METHODS Participants were 340 women , recruited through a network of primary care physicians . They received a baseline question naire in the mail , were r and omized to one of the three study arms , and completed a follow-up survey 3 months later . RESULTS Both types of counseling were very well received . The counseling decreased women 's cancer worry , risk perceptions , and intentions to pursue genetic testing . There were similar effects for both in-person and telephone counseling . CONCLUSION Genetic counseling can be used to inform women at all risk levels about their breast cancer risk . PRACTICE IMPLICATION S Breast cancer risk counseling can be done in-person and by telephone -- thereby reaching women in remote areas This study evaluated a mail and telephone intervention to improve breast health behaviors while maintaining quality of life . Women recruited from the general public were r and omized to a stepped-intensity intervention consisting of mailings , telephone calls , and counseling ( if requested or appropriate given a woman ’s genetic risk for breast cancer ) or to a delayed treatment control group . Outcomes ( mammography screening and quality of life ) were measured at baseline in a telephone survey and again at a 12-month follow-up period . Women in the intervention group significantly increased screening mammography uptake by 12 % and quality of life by 5.3 scale points compared to control participants . Changes in knowledge of breast cancer , genetic testing , and cancer worry all significantly predicted intervention changes . This successful intervention can help women make better breast health choices without causing increased worry Background . Eliciting patients ’ preferences within a framework of shared decision making ( SDM ) has been advocated as a strategy for increasing colorectal cancer ( CRC ) screening adherence . Our objective was to assess the effectiveness of a novel decision aid on SDM in the primary care setting . Methods . An interactive , computer-based decision aid for CRC screening was developed and evaluated within the context of a r and omized controlled trial . A total of 665 average-risk patients ( mean age , 57 years ; 60 % female ; 63 % black , 6 % Hispanic ) were allocated to 1 of 2 intervention arms ( decision aid alone , decision aid plus personalized risk assessment ) or a control arm . The interventions were delivered just prior to a scheduled primary care visit . Outcome measures ( patient preferences , knowledge , satisfaction with the decision-making process [ SDMP ] , concordance between patient preference and test ordered , and intentions ) were evaluated using pre study /post study visit question naires and electronic scheduling . Results . Overall , 95 % of patients in the intervention arms identified a preferred screening option based on values placed on individual test features . Mean cumulative knowledge , SDMP , and intention scores were significantly higher for both intervention groups compared with the control group . Concordance between patient preference and test ordered was 59 % . Patients who preferred colonoscopy were more likely to have a test ordered than those who preferred an alternative option ( 83 % v. 70 % ; P < 0.01 ) . Intention scores were significantly higher when the test ordered reflected patient preferences . Conclusions . Our interactive computer-based decision aid facilitates SDM , but overall effectiveness is determined by the extent to which providers comply with patient preferences Logistic regression analysis , which estimates odds ratios , is often used to adjust for covariables in cohort studies and r and omized controlled trials ( RCTs ) that study a dichotomous outcome . In case – control studies , the odds ratio is the appropriate effect estimate , and the odds ratio BACKGROUND Results are reported from a r and omized trial design ed to increase the accuracy of perceived breast cancer risk among callers to the NCI 's Cancer Information Service ( CIS ) ( n = 392 ) . METHODS CIS callers assigned to the intervention group ( n = 200 ) received a brief educational intervention and an estimate of breast cancer risk over the telephone at the end of usual service . Follow-up interviews were completed by telephone at 1 month ( n = 367 ) . RESULTS On average , women overestimated their risk by 25 percentage points . Eighty percent of the respondents rated their risk of breast cancer higher than did the assessment tool . Women rated their risk higher if they were under age 50 ( P = 0.025 ) or had a first-degree family history of breast cancer ( P = 0.0001 ) , and rated their risk lower if they were Latina ( P = 0.050 ) or Asian/other race/ethnicity ( P = 0.013 ) . Women with a first-degree family history of breast cancer in the intervention group significantly reduced their risk overestimate compared to those in the control group ( -12.5 vs. 2.8 percentage points , P = 0.006 ) . CONCLUSIONS This intervention was unique because it was delivered in an ongoing service setting . It should be further tested in diverse population BACKGROUND Most women are not getting regular mammograms , and there is confusion about several mammography-related issues , including the age at which women should begin screening . Numerous groups have called for informed decision making about mammography , but few programs have result ed . Our research is intended to fill this gap . METHODS We conducted a r and omized controlled trial , which ran from 1997 to 2000 . Women aged 40 to 44 and 50 to 54 , who were enrolled in Blue Cross Blue Shield of North Carolina , were r and omly assigned to one of three groups : usual care ( UC ) , tailored print ( TP ) material s , or TP plus tailored telephone counseling ( TP+TC ) . We assessed the impact of tailored interventions on knowledge about breast cancer and mammography , accuracy of breast cancer risk perceptions , and use of mammography at two time points after intervention-12 and 24 months . RESULTS At 12 and 24 months , women who received TP+TC had significantly greater knowledge and more accurate breast cancer risk perceptions . Compared to UC , they were 40 % more likely to have had mammograms ( odds ratio=0.9 - 2.1 ) . The effect was primarily for women in their 50s . TP had significant effects for knowledge and accuracy , but women who received TP were less likely to have had mammography . CONCLUSIONS Decision-making interventions , comprised of two tailored print interventions ( booklet and newsletter ) , delivered a year apart , with or without two tailored telephone calls , significantly increased knowledge and accuracy of perceived breast cancer risk at 12 and 24 months post-intervention . The effect on mammography use was significant in bivariate relationships but had a much more modest impact in multivariate analyses This study evaluated a tailored intervention to promote sun protection in parents and their children , hypothesizing that the tailored intervention would lead to improved skin cancer prevention behaviors compared to generic material s. Families were recruited through schools and community centers and were included if there was 1 child in Grade s 1–3 at moderate to high risk for skin cancer . Participants were r and omized into one of two intervention groups : a tailored intervention , in which they received personalized skin cancer education through the mail ; or a control group who received generic skin cancer information material s. Before and after intervention , parents completed question naires about their and their children 's skin cancer risk and prevention knowledge and behaviors . Parents also completed 4-day sun exposure and protection diaries for their child and themselves . Tailored group participants demonstrated significantly greater positive changes in prevention behavior after the intervention , including children 's use of sunscreen , shirts , and hats , and parents ' use of shade , and skin examinations . Effect sizes were small and perceived benefits and social norms mediated intervention effects . Findings from this study support the efficacy of focusing tailored communications to families in order to change skin cancer prevention practice s in young children
OBJECTIVE To provide a comprehensive review of the impact on intention to change health-related behaviours and health-related behaviours themselves , including screening uptake , of interventions incorporating information about cancer risk targeted at the general adult population .