Frequency format diagram and probability chart for breast cancer risk communication: a prospective, randomized trial

BackgroundBreast cancer risk education enables women make informed decisions regarding their options for screening and risk reduction. We aimed to determine whether patient education regarding breast cancer risk using a bar graph, with or without a frequency format diagram, improved the accuracy of risk perception.MethodsWe conducted a prospective, randomized trial among women at increased risk for breast cancer. The main outcome measurement was patients' estimation of their breast cancer risk before and after education with a bar graph (BG group) or bar graph plus a frequency format diagram (BG+FF group), which was assessed by previsit and postvisit questionnaires.ResultsOf 150 women in the study, 74 were assigned to the BG group and 76 to the BG+FF group. Overall, 72% of women overestimated their risk of breast cancer. The improvement in accuracy of risk perception from the previsit to the postvisit questionnaire (BG group, 19% to 61%; BG+FF group, 13% to 67%) was not significantly different between the 2 groups (P = .10). Among women who inaccurately perceived very high risk (≥ 50% risk), inaccurate risk perception decreased significantly in the BG+FF group (22% to 3%) compared with the BG group (28% to 19%) (P = .004).ConclusionBreast cancer risk communication using a bar graph plus a frequency format diagram can improve the short-term accuracy of risk perception among women perceiving inaccurately high risk.

[1]  C. McHorney,et al.  Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[2]  R Fuller,et al.  How informed is consent? Understanding of pictorial and verbal probability information by medical inpatients , 2002, Postgraduate medical journal.

[3]  Nancy L. Kocovski,et al.  Perception of Quantitative Information for Treatment Decisions , 2000, Medical decision making : an international journal of the Society for Medical Decision Making.

[4]  J. G. Hollands,et al.  The visual communication of risk. , 1999, Journal of the National Cancer Institute. Monographs.

[5]  M. Gail,et al.  Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. , 1989, Journal of the National Cancer Institute.

[6]  Damian McEntegart,et al.  The Pursuit of Balance Using Stratified and Dynamic Randomization Techniques: An Overview , 2003 .

[7]  A. Stiggelbout,et al.  Different formats for communicating surgical risks to patients and the effect on choice of treatment. , 2004, Patient education and counseling.

[8]  B. Rimer,et al.  Effects of individualized breast cancer risk counseling: a randomized trial. , 1995, Journal of the National Cancer Institute.

[9]  J F Jekel,et al.  Perils, pitfalls, and possibilities in talking about medical risk. , 1999, JAMA.

[10]  B. Rimer,et al.  Communicating breast cancer risks to women using different formats. , 2001, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[11]  P. Butow,et al.  Development of a Communication Aid to Facilitate Risk Communication in Consultations with Unaffected Women from High Risk Breast Cancer Families: A Pilot Study , 2006, Journal of Genetic Counseling.

[12]  M. Schapira,et al.  The Influence of Graphic Format on Breast Cancer Risk Communication , 2006, Journal of health communication.

[13]  B. Rimer,et al.  Relationships among breast cancer perceived absolute risk, comparative risk, and worries. , 2000, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[14]  W. Cleveland,et al.  Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods , 1984 .

[15]  K. Ghosh,et al.  Breast Cancer Risk Communication: Modalities and Effectiveness , 2005, The breast journal.

[16]  GERD,et al.  New Directions in Judgment and Decision Making The Psychology of Good Judgment : Frequency Formats and Simple Algorithms , 2006 .

[17]  C K Redmond,et al.  Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. , 1999, Journal of the National Cancer Institute.

[18]  G. Gigerenzer,et al.  Simple tools for understanding risks: from innumeracy to insight , 2003, BMJ : British Medical Journal.

[19]  R Fuller,et al.  Risk communication and older people-understanding of probability and risk information by medical inpatients aged 75 years and older. , 2001, Age and ageing.