A systematic review of risk communication in clinical trials: how does it influence decisions to participate and what are the best methods to improve understanding in a trial context?

Maeve Coyle, Kate Gillies* (Corresponding Author)

*Corresponding author for this work

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Effective risk communication is challenging. Ensuring potential trial participants’ understand ‘risk’ information presented to them is a key aspect of the informed consent process within clinical trials, yet minimal research has looked specifically at how to communicate probabilities to support decisions about trial participation. This study reports a systematic review of the literature focusing on presentation of probabilistic information or understanding of risk by potential trial participants.

A search strategy for risk communication in clinical trials was designed and informed by systematic reviews of risk communication in treatment and screening contexts and supplemented with trial participation terms. Extracted data included study characteristics and the main interventions/findings of each study. Explanatory studies that investigated the methods for presenting probabilistic information within participant information leaflets for a clinical trial were included, as were interventions that focused on optimising understanding of probabilistic information within the context of a clinical trial.

The search strategy identified a total of 4931 studies. Nineteen papers were selected for full text screening, and seven studies included. All reported results from risk communication studies that aimed to support potential trial participants’ decision making set within hypothetical trials. Five of these were randomised comparisons of risk communication interventions, and two were prospectively designed, non-randomised studies. Study interventions focused on probability presentation, risk framing and risk interpretation with a wide variety of interventions being evaluated and considerable heterogeneity in terms of outcomes assessed. Studies show conflicting findings when it comes to how best to present information, although numerical, particularly frequency formats and some visual aids appear to have promise.

The evidence base surrounding risk communication in clinical trials indicates that there is as yet no clear optimal method for improving participant understanding, or clear consensus on how it affects their willingness to participate. Further research into risk communication within trials is needed to help illuminate the mechanisms underlying risk perception and understanding and provide appropriate ways to present and communicate risk in a trial context so as to further promote informed choices about participation. A key focus for future research should be to investigate the potential for learning in the evidence on risk communication from treatment and screening decisions when applied to decisions about trial participation.
Original languageEnglish
Article numbere0242239
JournalPloS ONE
Issue number11
Publication statusPublished - 16 Nov 2020

Bibliographical note

The data underlying the results presented in the study are available from the published papers. Included studies available here: Reference 22 - DOI: 10.1177/009286150604000302 Reference 23 - DOI: 10.1542/peds.2009-1796 Reference 24 - DOI: 10.1177/1740774515585120 Reference 25 - DOI: 10.1017/S1357530902000558 Reference 26 - DOI: 10.1097/00000539-200302000-00037 Reference 27 - DOI: 10.1186/1472-6947-10-55 Reference 28 - DOI: 10.1177/014107689008300710.

The authors would like to acknowledge Cynthia Fraser for help designing and running the search strategies and Paul Manson for updating the search.


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