A TAILORED APPROACH TO RISK COMMUNICATION IN DECISION AIDS: FINDING THE OPTIMAL FORMAT FOR INDIVIDUALS

Purpose: The inability to understand and use numerical information in health care decisions has been independently associated with poor patient decision making and worse health outcomes. Research has also found the presentation format can affect patient numerical comprehension. Here, we extend this line of investigation to examine whether decision support tools can be tailored to improve women’s understanding of hereditary breast cancer risks based on women’s informed preferences for presentation format.

Methods: Women at increased risk for breast cancer were recruited through the Cancer Genetics Network. Participants were initially asked for their preferred format of risk communication including: percentages, frequencies, bar graphs, pictograms, and comparison to average risks. They were then presented with a statement about risks associated with BRCA mutations using various risk communication formats and asked to answer a question that required them to interpret the risk information presented. After using the formats, participants were again asked to indicate their preferred format. 

Results: 380 women enrolled and completed the study. Although pictograms and bar graphs are considered to be more effective, almost no participants initially preferred these (Table 1). Instead, 54% preferred percentages, 25% preferred a comparison to others, and 17% preferred frequencies. Presentation format had little influence on the ability to interpret risk information: 72-75% identified the correct interpretations in each format. However, only 53% interpreted all formats correctly, and 27% correctly interpreted less than half of the formats. Once the participants had an opportunity to use each format, 58% changed their preferences (Table 1).  Among those who shifted their preferences to bar graphs or pictograms, the accuracy of interpretation was 65%, compared to 45% among those who preferred these graphs initially.

Conclusion: Women at risk for breast cancer appear to change their preference for receiving risk information once they have had experience with the different formats. Ability to correctly interpret risk information was also related to shift towards graphical representations. Informed preference regarding risk communication format may better predict risk perception abilities for some. While these results need further validation they suggest that interactive approaches to tailoring presentation of risk information may improve risk perception.

Format	Initial Preference	Final preference
Percentages	54%	32%
Frequencies	17%	9%
Bar graphs	2%	41%
Pictograms	0%	9%
Comparison to other women	25%	8%