Accurate Risk Perceptions Research Articles

Anchoring-and-Adjustment Bias in Communication of Disease Risk

Over the next decade, advances in genomics will make it increasingly possible to provide patients with personalized, genetic-based risks of common diseases, allowing them the opportunity to take preventive steps through behavioral changes. However, previous research indicates that people may insufficiently adjust their subjective risk to the objective risk value communicated to them by a healthcare provider, a phenomenon called anchoring-and-adjustment bias. In this narrative review, we analyze existing research on how patients process disease-risk information, and the processing biases that may occur, to show that the bias observed in disease-risk communication is potentially malleable to change. We recommend that, to reduce this bias and change patients' misperceptions of disease risk in clinical settings, future studies investigate the effects of forewarning patients about the bias, tailoring risk information to their numeracy level, emphasizing social roles, increasing motivation to form accurate risk perception, and reducing social stigmatization, disease worry and information overload.

Preventive Health Behavior and Adaptive Accuracy of Risk Perceptions

This study examined the relation between health behavior and risk perceptions in the context of an acute livestock epidemic. Participants in a longitudinal web-based survey (N= 195) were asked to report their meat consumption and their perceived risk in relation to bovine spongiform encephalopathy (BSE) and other related livestock diseases. Cross-sectional analyses at both measurement points (T1 and T2) showed that participants with low levels of preventive nutrition (high meat consumption) felt more at risk for BSE-related diseases than those reporting comparable higher levels of preventive behavior (low meat consumption), indicating relative accuracy. These results suggest that people recognize when their behavior is risky. More importantly, perceived risk also showed adaptive accuracy from a change perspective: increases in preventive nutrition from T1 to T2 were significantly associated with decreases in perceived risk between T1 and T2. Possible foundations and implications of an adaptive accuracy of risk perceptions are discussed.

Volcanic risk perception of young people in the urban areas of Vesuvius: Comparisons with other volcanic areas and implications for emergency management

More than 600 000 people are exposed to volcanic risk in the urban areas near the volcano, Vesuvius, and may need to be evacuated if there is renewed volcanic activity. The success of a future evacuation will strongly depend on the level of risk perception and preparedness of the at-risk communities during the current period of quiescence. The volcanic risk perception and preparedness of young people is of particular importance because hazard education programs in schools have been shown to increase the clarity of risk perception and students often share their knowledge with their parents. In order to evaluate young people's risk perception and preparedness for a volcanic crisis, a multiple choice questionnaire was distributed to 400 high-school students in three municipalities located close to the volcano. The overall results suggest that despite a 60-year period of quiescence at Vesuvius, the interviewed students have an accurate perception of the level of volcanic risk. On the other hand, the respondents demonstrate a clear lack of understanding of volcanic processes and their related hazards. Also, the interviewed students show high levels of fear, poor perceived ability to protect themselves from the effects of a future eruption, and insufficient knowledge of the National Emergency Plan for Vesuvian Area (NEPVA). The latter result suggests that in comparison with volcanic crises in other regions, during a future eruption of Vesuvius, there may not be enough time to educate the large number of people living near the volcano about how to appropriately respond. The inadequate risk education and preparedness of respondents implies that a strong effort is needed to improve communication strategies in order to facilitate successful evacuations. Therefore, it is important to take advantage of the present period of quiescence at Vesuvius to improve the accuracy of risk perception of youth in local communities.

Perceived and Actual Stroke Risk Among Men With Hypertension

The purposes of this study were to determine whether there is a significant correlation between the perceived and actual stroke risk among hypertensive patients and to identify patient characteristics associated with inaccurate estimation of stroke risk. The authors performed a cross-sectional analysis of 296 men with hypertension who were enrolled in the Veterans Study to Improve the Control of Hypertension (V-STITCH). A patient's actual stroke risk was calculated using the Framingham stroke risk (FSR); patients' perceived risk was measured according to a self-reported 10-point risk scale. The median 10-year FSR was 16%, but the median perceived risk score was 5 (range, 1 [lowest] to 10 [highest]). There was no significant correlation between patients' perceived risk of stroke and their calculated FSR (Spearman rho=-0.08; P=.16; 95% confidence interval, -0.19 to 0.03). Patients who underestimated their stroke risk were significantly less likely to be worried about their blood pressure than patients with accurate risk perception (12.4% vs 69.6%; P<.0001). The lack of correlation between hypertensive patients' perceived stroke risk and FSR supports the need for better patient education on the risks associated with hypertension.

Television news' coverage of motor-vehicle crashes

Problem Traffic crashes are a major cause of injury and death. Although it has been argued that a skewed estimation of personal risks may be partly attributable to news representations of mortality causes, the manners in which traffic crashes are covered in the news have not received much attention in the literature. Method The current study used content analysis to examine the framing of traffic crashes in television news. Results The data indicated that Flemish television news does not report traffic crashes from a public health perspective and consequently it misses opportunities to inform the public on the causes and consequences of risk-taking in traffic. Impact on industry It is important that professionals are aware of these findings and stress contextual factors surrounding traffic crashes in their communication with journalists. This may lead to more accurate reports and a more accurate risk perception of viewers.

Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis

To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS). Five electronic databases (to July 2006) and personal contacts (to December 2006). Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI = 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = -8.4, 95% CI = -11.9 to -4.8; unclear values WMD = -6.3, 95% CI = -10.0 to -2.7). There was no difference in process measures when detailed and simple PtDAs were compared. PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures. The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.

Reporting a Potential Pandemic

While quality mediated information does not guarantee accurate public risk perceptions, it provides the public with the means to construct informed risk assessments. This study analyzed four major U.S. newspapers to assess the quality of coverage related to risks posed by avian flu. “Quality of coverage” was examined with a five-dimension conceptualization that included measures of risk magnitude, self-efficacy, risk comparisons, sensationalism, and thematic and episodic framing. Findings revealed that coverage was dominated by episodic frames, exhibited high sensationalism, and contained minimal information promoting self-efficacy. Conversely, coverage exhibited high quality in terms of risk magnitude and risk comparison information.

Perceived risk of chlamydial and gonococcal infection among sexually experienced young adults in the United States.

Understanding young adults' perceived risk of chlamydial and gonococcal infection can inform interventions to reduce the prevalence of these sexually transmitted diseases. Bivariate and multivariate analyses, using data from Wave 3 of the National Longitudinal Study of Adolescent Health (2001-2002), were conducted to examine relationships between perceived risk and selected characteristics in two groups: a nationally representative sample of sexually experienced 18-26-year-olds and a subsample of those who tested positive for chlamydia or gonorrhea. The relationship between current infection and perceived risk was also evaluated. Only 14% of all respondents and 33% of infected participants reported some perceived risk of chlamydial or gonococcal infection. In the overall sample, the odds of perceiving risk were significantly elevated among blacks, Hispanics, unmarried respondents, inconsistent condom users and nonusers, respondents who reported multiple partners in the past year, those who had received a diagnosis of chlamydia or gonorrhea in the past year, and those reporting current symptoms (odds ratios, 1.5-3.3). Currently infected participants were significantly more likely than those who were not infected to perceive some risk of infection (2.4). Among infected respondents, the factors positively associated with perceived risk were being black or Hispanic, using condoms inconsistently or not using them, having exchanged money for sex, having been tested in the past year but with no diagnosis, having received a diagnosis, and reporting current symptoms (2.5-5.2). Interventions to increase the accuracy of young adults' risk perceptions may influence sexual and health care-seeking behaviors in a way that will reduce rates of chlamydia and gonorrhea.

The Genomic Era and Serious Mental Illness: A Potential Application for Psychiatric Genetic Counseling

Genetic counseling is an important clinical service that is routinely offered to families affected by genetic disorders or by complex disorders for which genetic testing is available. It is not yet routinely offered to individuals with serious mental illnesses and their families, but recent findings that beliefs about the cause of mental illness can affect an individual's adaptation to the illness suggest that genetic counseling may be a useful intervention for this population. In a genetic counseling session the counselor discusses genetic and environmental contributors to disease pathogenesis; helps individuals explore conceptions, fears, and adaptive strategies; and provides nondirective support for decision making. Expected outcomes may include reductions in fear, stigma, and guilt associated with a psychiatric diagnosis; improvements in adherence to prescribed medications; declines in risk behaviors; and reductions in misconceptions about the illness. The authors endorse a multidisciplinary approach in which a psychiatrist and genetic counselor collaborate to provide comprehensive psychiatric genetic counseling.

Risk perception among women receiving genetic counseling: A population-based follow-up study

Background: We aimed to explore the impact of genetic counseling on perceived personal lifetime risk of breast cancer, the accuracy of risk perception, and possible predictors of inaccurate risk perception 1 year following counseling. Methods: We conducted a population-based prospective follow-up study of 213 women who received genetic counseling for hereditary breast and ovarian cancer, 319 women who underwent mammography (Reference Group I), and a random sample of 1070 women from the general population (Reference Group II). Results: Women who received genetic counseling decreased their perceived risk by an average of 6.6 percentage points (95% CI: 3.0%; 10.2%) between baseline and 12 months of follow-up. In contrast, perceived risk remained relatively stable in the reference groups. The proportion of women who accurately perceived their risk increased by 16% in the group receiving genetic counseling, compared to a reduction of 5% ( p = 0.03) and 2% ( p = 0.01) in Reference Groups I and II, respectively. Risk communicated only in words, inaccurate risk perception at baseline, and presence of a familial mutation appeared to be predictors of inaccurate risk perception 12 months after counseling. Conclusion: This population-based study of women with a family history of breast or ovarian cancer indicates that genetic counseling can help them both to reduce their perceived risk and to achieve a more realistic view of their risk of developing breast cancer.

The genomic era and perceptions of psychotic disorders: Genetic risk estimation, associations with reproductive decisions and views about predictive testing

As a result of publicity surrounding genetic advances, increasing public awareness of a genetic role in major mental illness may be contributing to a "geneticization" of these illnesses. Geneticization could lead to oversimplified ideas about genetic risk, producing significant social consequences. We sought to investigate perceptions of genetic risk, associated effects on reproductive decisions and attitudes towards genetic testing amongst unaffected relatives of individuals with psychosis. A web-based survey design was used, which all visitors to a psychosis support/information website had the option to complete. Responders were representative of website visitors, and the study design facilitated collection of a large dataset, although the response rate was low. Over-estimating risk was associated with reproductive decisions favoring fewer children, and more positive attitudes towards genetic testing. Facilitating accurate risk perception through genetic counseling could significantly impact reproductive decisions, and the appropriate use of genetic tests in the future.

Patients with acute myocardial infarction have an inaccurate understanding of their risk of a future cardiac event

Accurate perceptions of future cardiac risk are important to ensure informed treatment choices and lifestyle adaptation in patients following myocardial infarction (MI). The aim of this study was to investigate whether risk perceptions of patients with MI were accurate compared with an established clinical risk model. Seventy-nine consecutive patients with acute MI admitted to the Coronary Care Unit, Auckland Hospital, completed a questionnaire assessing risk perceptions. Clinical data were used to calculate patients' Thrombolysis In Myocardial Infarction (TIMI) risk scores, a validated predictive model of prognosis. The main outcome measures were the associations between perceived risk, TIMI risk scores and troponin T. Patients' risk perceptions showed no correlation with thrombolysis in myocardial infarction risk scores (r = -0.06; P = 0.61) or with troponin T (r = -0.07; P = 0.53). Patients' risk perceptions were not significantly associated with age or sex, and were not significantly higher in those who had experienced a previous MI, a family history of coronary heart disease, diabetes or smokers. Higher perceived risk was significantly associated with a number of illness perceptions, including worse consequences of the MI and lower beliefs in the benefit of treatment. Patients who overestimated their risk were more anxious than other patients (F(2, 73) = 22.97; P = 0.0001). Patients with MI ideas about their personal risk of future MI are not congruent with their clinical risk assessments. Inpatient hospital care appears to be unsuccessful in communicating prognosis effectively to patients. Improving the accuracy of risk perceptions may help decrease unnecessary cardiac anxiety and invalidism in some patients and prompt risk-reducing behaviours in others.

Rural Parents' Perceptions of Risks Associated with Their Children's Exposure to Radon

To examine the level of awareness of radon issues, correlates of elective testing behaviors, and the accuracy of risk perception for radon exposures among rural residents receiving public health services. A cross-sectional design was used in which questionnaire data and household analytic data for radon levels were collected from a nonprobabilistic sample of rural households. Thirty-one rural households with 71 adults and 60 children participated in the study. Primary household respondents were female (100%), Caucasian (97%), and primarily (94%) between 21 and 40 years of age. Questionnaire data consisted of knowledge and risk perception items about radon and all homes were tested for the presence of radon. The prevalence of high airborne radon (defined as> or=4 pCi/l) was 32%. More than a third of the sample underestimated the seriousness of health effects of radon exposure, 39% disagreed that being around less radon would improve the long-term health of their children, and 52% were unsure whether radon could cause health problems. After adjusting for chance, only 21% of the subjects correctly understood their risk status. This study provides preliminary evidence that low-income rural citizens do not understand their risk of radon exposure or the deleterious consequences of exposure.

Risk and Rationality in Adolescent Decision Making: Implications for Theory, Practice, and Public Policy.

Risk and Rationality in Adolescent Decision Making: Implications for Theory, Practice, and Public Policy.

Factors associated with colorectal cancer risk perception: the role of polyps and family history

It is unclear how objective risk factors influence the factors associated with colorectal cancer (CRC) risk perception. The goals of this study were to investigate factors associated with perceived risk of CRC and to explore how these relationships were modified by personal history of polyps or family history of CRC. The study involved a mailed questionnaire completed by 1646 men and women aged 50-75 years, which assessed perceived risk, demographic and health history variables and CRC worry. Participants were patients of primary care providers in a community medical group in central Massachusetts. The study sample seemed to have a generally accurate perception of CRC risk, which was appropriately increased in the presence of known risk factors. In multivariable analyses that controlled for all measured covariates, financial situation modified the association between perceived risk and a personal history of polyps, while age and insurance status modified the association between perceived risk and family history of CRC. CRC worry, self-reported health, personal history of other cancer and compliance with screening guidelines remained significant predictors of perceived risk. Potential interactions between objective risk factors and socioeconomic characteristics should be further explored in longitudinal studies.

Black-white differences in risk perceptions of breast cancer survival and screening mammography benefit

Given differences in cancer survival by race, black women may differ from white women in breast cancer risk perceptions. To evaluate black-white differences in risk perceptions of breast cancer survival and screening mammography benefit. A written survey was administered to a random sample of women attending general internal medicine clinics. Black and white women, ages 40 to 69. Risk perceptions were measured regarding (1) average 5-year survival after a breast cancer diagnosis and (2) relative risk reduction of screening mammography. Women's risk perceptions were defined as being accurate, as well as more or less pessimistic. Measured patient characteristics included race, age, family history of breast cancer, income, insurance, education, and numeracy. Unadjusted Pearson chi(2) tests and adjusted multivariable regression analyses were done. Black women were more likely than white women to accurately perceive breast cancer survival in both unadjusted (48% vs 26%, P<.001) and adjusted analyses (adjusted odds ratio (AOR)=3.58; 95% confidence interval (CI)=1.56 to 8.21). Black women were also more likely to accurately perceive the benefit of screening mammography in unadjusted (39% vs 15%, P<.001) and adjusted analyses (AOR=2.70; 95% CI=1.09 to 6.69). Black women were more likely to have a more pessimistic perception of mammography benefit in unadjusted (47% vs 15%, P<.0001) and adjusted analyses (AOR=3.94; 95% CI=1.62 to 9.56). Awareness of risk perceptions can help physicians to tailor patient education. Physician acknowledgment of more accurate risk perceptions among black women may serve as a basis to improve patient-physician communication.

Cardiac risk underestimation in urban, black women

Black women have a disproportionately higher incidence of cardiovascular disease mortality than other groups and the reason for this health disparity is incompletely understood. Underestimation of personal cardiac risk may play a role. We investigated the personal characteristics associated with underestimating cardiovascular disease in black women. Trained surveyors interviewed 128 black women during the baseline evaluation for a randomized controlled trial in an urban, academic continuity clinic affiliated with a public hospital system. They provided information on the presence of cardiac risk factors and demographic and psychosocial characteristics. These self-report data were supplemented with medical record abstraction for weight. The main outcome measure was the accurate perception of cardiac risk. Objective risk was determined by a simple count of major cardiac risk factors and perceived risk by respondent's answer to a survey question about personal cardiac risk. The burden of cardiac risk factors was high in this population: 77% were obese; 72% had hypertension; 48% had high cholesterol; 49% had a family history of heart disease; 31% had diabetes, and 22% currently used tobacco. Seventy-nine percent had 3 or more cardiac risk factors. Among those with 3 or more risk factors ("high risk"), 63% did not perceive themselves to be at risk for heart disease. Among all patients, objective and perceived cardiac risk was poorly correlated (kappa=0.026). In a multivariable model, increased perceived personal stress and lower income were significant correlates of underestimating cardiac risk. Urban, disadvantaged black women in this study had many cardiac risk factors, yet routinely underestimated their risk of heart disease. We found that the strongest correlates of underestimation were perceived stress and lower personal income.

The Perception of Cancer Risk in Patients With Prevalent Barrett’s Esophagus Enrolled in an Endoscopic Surveillance Program

Patients with Barrett's esophagus (BE) have a risk of esophageal adenocarcinoma of approximately 0.5% per year. Patients may have difficulty understanding this risk. This study assessed the perceived risk of cancer in patients with BE, and correlated their risk estimates with their health care use behaviors. We performed a survey of patients with BE participating in an endoscopic surveillance program at 2 sites: a university teaching hospital and a Veterans' Administration hospital. A questionnaire also elicited their demographics as well as their sources of health information. Health care behaviors, including physician visits and endoscopic surveillance behaviors, were assessed. Patients were classified as either overestimators or nonoverestimators of risk. Characteristics of overestimators, as well as health care use patterns, were assessed. One hundred eighteen patients met entry criteria, and 92 (78%) completed all the questionnaires. Sixty-eight percent of patients overestimated their 1-year risk of cancer, with a mean estimated 1-year cancer risk being 13.6%. The lifetime risk also was overestimated by 38% of patients. Patients who overestimated risk were more likely to be Veterans' Administration medical center patients, have more symptomatic reflux, and were more likely to use the Internet to get health care information. There was no significant difference in physician visits between overestimators and nonestimators (1.2 visits per year vs 1.0, P = .20), nor in endoscopy use (5.7 endoscopies per 5-year period vs 5.0, P = .42). The majority of patients with prevalent BE participating in an endoscopic surveillance program overestimated their chances of developing adenocarcinoma of the esophagus. Efforts to improve education of such patients with BE are warranted.

Efficacy of cancer risk assessment (CRA) through teleconferencing

6024 Background: The goals of CRA are reducing anxiety and increasing risk perception accuracy. CRA, a type of genetic counseling, potentially reduces morbidity and mortality from cancer by prescribing optimal medical management. Traditional CRA is performed in person. Since there are less than 500 certified cancer genetic counselors (CGC) in the U. S. there is a need for improving access to CRA. Methods: A prospective, randomized study tested the benefits of CRA by a CGC through teleconference (TC) versus face-to-face (FTF) counseling in decreasing anxiety and increasing accuracy of risk perception. The teleconference method, an easily deployable system, combined a Power Point presentation with telephone teleconferencing. Patients who were referred with a strong personal or family history of cancer were offered the opportunity to enter the trial. A baseline telephone assessment was conducted prior to the CRA with follow-up assessment five to seven days after the session. Outcomes were measured by the Profile of Mood States (POMS), State/Trait Anxiety Inventory (STAI), and Impact of Events (IOE) Scales, together with the patient’s perceived risk assessment. Results: Accrual to FTF was 45 and to TC 48. Pre- and post-CRA testing with POMS, IOE, STAI, and risk assessment showed statistically significant improvement by paired t tests for both groups except the State score of the STAI for the TC group. There was no significant difference by t test in any of the outcome measures for FTF and TC groups. Conclusions: These results establish the equivalent efficacy of teleconferencing CRA with standard face-to-face CRA. This easily applied TC method can increase access, provide clinical benefit, and may allow short- and long-term cost savings. Finally, TC CRA serves as a model for other remote counseling applications. The views expressed in this abstract are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the United States Government. No significant financial relationships to disclose.

Patients’ Resistance to Risk Information in Genetic Counseling for BRCA1/2

Risk information from health care providers is relevant to and used in nearly all medical decisions. Patients often misunderstand their risks, yet little is known about the risk perception that patients derive from risk communications with health care providers. This study examines patients' risk perceptions following communication with health care providers during genetic counseling about the risks of breast cancer and BRCA1/2 mutations. A prospective, longitudinal study was conducted from October 2002 to February 2004 of women who received genetic counseling. The women completed a survey before their counseling and a telephone interview in the week after the counseling. Main outcome measures included change from precounseling in risk perception and accuracy of postcounseling risk perception (relative to actual risk information communicated). A total of 108 women agreed to participate in the study. The women's postcounseling risk perceptions were significantly lower than their precounseling risk perceptions (breast cancer: 17%, P<.001; mutation: 13%, P<.001) but were significantly higher than the actual risk information communicated (breast cancer: 19%, P<.001; mutation: 24%, P<.001). Accuracy of breast cancer risk perception but not mutation risk perception was associated with precounseling worry (P = .04), even after adjusting for trait anxiety (P = .01). This research demonstrates patients' resistance to risk information. Inappropriately high risk perception derived from a risk communication with a health care provider can lead patients to make different, and potentially worse, medical decisions than they would with an accurate risk perception and to be unnecessarily distressed about their risk.