How effective are 'age' tools at changing patient behaviour? A rapid review.
Kulendrarajah B., Grey A., Nunan D.
BACKGROUND: A common form of risk communication is to relay the relative risk (%) of an adverse outcome based on surrogate markers associated with the outcome. A novel way of communicating risk is through 'effective age' of a person or specific organ. These tools can be used to change patient behaviour. OBJECTIVE: To determine the effect of 'effective age' tools on patient behaviour as compared with more traditional methods of risk communication. STUDY SELECTION: We performed a search of the PubMed database up to February 2019 for systematic reviews and randomised controlled trials (RCT) that answered our question. Interventions were 'effective age' tools, comparators were usual care or alternative risk communication tools. Primary outcomes were behavioural change measures. FINDINGS: We included 1 overview of systematic reviews (level 1 evidence), 2 systematic reviews (level 1 evidence) and 13 RCTs (level 2 evidence). Both systematic reviews concluded the evidence base was not conclusive enough to make specific recommendations.Age tools assessed in the 13 RCTs were: 'lung age' (n=5), 'heart age' (n=3), 'health age' (n=2), 'cardiovascular age' (n=1), 'body age' (n=1) and 'net present value' (n=1). 7/13 (54%) RCTs demonstrated a clinical effect on behaviour change favouring the 'age' tool; 2/13 (15%) demonstrated a null effect; 4/13 (31%) favoured control. CONCLUSIONS: Our findings indicate that systematic review evidence needs updating. The evidence from RCTs on the effect of using age metrics on patient behaviour is poor. There is a need for high-quality trials to decrease uncertainty in the available evidence.