title: Cancer risk assessment tools in primary care: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  We 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).
  
  
  METHODS
  We 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.
  
  
  RESULTS
  The 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.
authors.affiliation: Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia walker@unimelb.edu.au.
authors.forename: J G
authors.initials: JG
authors.lastname: Walker
authors.affiliation: Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Licqurish
authors.affiliation: Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia.
authors.forename: P P C
authors.initials: PP
authors.lastname: Chiang
authors.affiliation: Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Pirotta
authors.affiliation: Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia General Practice, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, Australia The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: J D
authors.initials: JD
authors.lastname: Emery
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment
keywords: cancer screening; practice-based research; primary care; risk assessment tools