Impact of communicating genetic risk estimates on risk-reducing health behaviour: systematic review with meta-analysis

Abstract

Background: DNA-based disease risk information is becoming widely available. Expectations are high that communicating this information motivates behaviour change to reduce risk. The objective of this review was to update an earlier Cochrane review assessing the impact of communicating genetic risk estimates on risk-reducing health behaviours. Methods: 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. We searched five electronic databases including MEDLINE, Embase, and PsycINFO, and conducted backward and forward citation searches. We included 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. Findings: We examined 10,515 abstracts and included 18 studies, 11 more than our previous review. Meta-analysis revealed no statistically significant effects of communicating DNA-based risk estimates on smoking cessation (OR 0.92, 95% CI 0.63,1.35, n=2663, p = 0.67), physical activity (SMD -0.03, 95% CI -0.13,0.08, n = 1704, p=0.62) or diet (SMD 0.12, 95% CI -0.00,0.24, n = 1784, p = 0.05). There were also no effects on any other behaviours), on motivation to change behaviour, and no adverse effects, including depression and anxiety. Discussion: 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.