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Risky Communication: Pitfalls in Counseling About Risk, and How to Avoid Them

A genetic counselor is often faced with the difficult task of conveying a set of complex and highly abstract factors associated with the client's risk of developing a familial disorder. The client is faced with the even more difficult task of making significant health-related decisions about an event which may or may not eventuate. Although there is a large corpus of research on this topic, much of the knowledge on risk communication is difficult to apply in a practical context. In this paper we draw together some insights on risk communication and decision-making under conditions of uncertainty, and apply them directly to the problem of communicating familial cancer risk. In particular, we focus on the distinction between individual risk and observed frequencies of adverse events, various framing effects, and contextualizing risk communication. We draw attention to some of the potential pitfalls in counseling about risk and offer avenues for circumventing them.

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REFERENCES

  • Bernstein, P. L. (1996). Against the gods: The remarkable story of risk. New York: John Wiley & Sons.

    Google Scholar 

  • Barratt, A., Wyer, P. C., Hatala, R., McGinn, T., Dans, A. L., Keitz, S., Moyer, V., & Guyatt, G. (2004). Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. CMAJ, 171(4), 353–358.

    Article  Google Scholar 

  • Claus, E. B. (2001). Risk models used to counsel women for breast and ovarian cancer: A guide for clinicians. Familial Can, 1, 197–206.

    CAS  Article  Google Scholar 

  • Edwards, A., Elwyn, G., & Mulley, A. (2002). Explaining risks: Turning numerical data into meaningful pictures. Br Med J, 324, 827–830.

    Article  Google Scholar 

  • Facione, N. C. (2002). Perceived risk of breast cancer: influence of heuristic thinking. Can Prac, 10(5), 256–262.

    Article  Google Scholar 

  • Fahey, T., Griffiths, S., Peters, T. J., Milne, R., & Sackett, D. (1995). Evidence based purchasing: understanding results of clinical trials and systematic reviews. Br Med J, 311(7012), 1056–1061.

    CAS  Article  Google Scholar 

  • Gigerenzer, G. (2002). Reckoning with risk: Learning to live with uncertainty. London: Penguin.

    Google Scholar 

  • Gigerenzer, G., & Edwards, A. (2003). Simple tools for understanding risks: from innumeracy to insight. Br Med J, 327, 741–744.

    Article  Google Scholar 

  • Hallowell, N. (1998). ‘You don't want to lose your ovaries because you think ‘I might become a man.’ ‘Women's perceptions of prophylactic surgery as a cancer risk management option. Psycho-Oncology, 7, 263–275.

    CAS  Article  Google Scholar 

  • Hallowell, N. (2000). A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy. Psycho-Oncology, 9, 486–495.

    CAS  Article  Google Scholar 

  • Hallowell, N., Statham, H., Murton, F., Green, J., & Richards, M. (1997). “Talking about chance”: The presentation of risk information during genetic counseling for breast and ovarian cancer. J Gen Counsel, 6(3), 269–286.

    CAS  Article  Google Scholar 

  • Hamm, R. M., & Smith, S. L. (1998). The accuracy of patients’ judgments of disease probability and test sensitivity and specificity. J Fam Prac, 47(1), 44–53.

    CAS  Google Scholar 

  • Hodge, S. E. (1998). A simple, unified approach to bayesian risk calculations. J Gen Counsel, 7(3), 235–261.

    CAS  Article  Google Scholar 

  • Jaynes, E. T. (2003). Probability theory: The logic of science. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Johnson, B. B. (2004). Risk comparisons, conflict, and risk acceptability claims. Risk Anal, 24(1), 131–145.

    Article  Google Scholar 

  • Jones, S. K., Frisch, D., Yurak, T. J., & Kim, E. (1998). Choices and opportunities: Another effect of framing on decisions. J Behav Dec Mak, 11, 211–226.

    Article  Google Scholar 

  • Kahneman, D., & Tversky, A. (1984). Choices, values, and frames. Am Psychol, 39(4), 342–347.

    Article  Google Scholar 

  • Kahneman, D., & Tversky, A. (Eds.). (2000). Choices, values, and frames. Cambridge: Cambridge University Press.

    Google Scholar 

  • Kreuter, M. W. (1999). Dealing with competing and conflicting risks in cancer communication. J Nat Can Inst Mono, 25, 27–35.

    Article  Google Scholar 

  • Kuhn, K. M. (1997). Communicating uncertainty: framing effects on responses to vague probabilities. Organ Behav Hum Dec Proc, 71(1), 55–83.

    Article  Google Scholar 

  • Leventhal, H., Kelly, K., & Leventhal, E. A. (1999). Population risk, actual risk, perceived risk, and cancer control: A discussion. J Nat Can Inst Mono, 25, 81–85.

    Article  Google Scholar 

  • Lippman-Hand, A., & Fraser, F. C. (1979). Genetic counseling—The postcounseling period: I. Parents’ perceptions of uncertainty. Am J Med Genet, 4(1), 51–71.

    CAS  Article  Google Scholar 

  • Lupton, D. (Ed.). (1999). Risk and sociocultural theory. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Malenka, D. J., Baron, J. A., Johansen, S., Wahrenberger, J., & Ross, J. (1993). The framing effect of relative and absolute risk. J Gen Int Med, 8(10), 543–548.

    CAS  Article  Google Scholar 

  • Marteau, T. M. (1999). Communicating genetic risk information. Br Med Bull, 55(2), 414–428.

    CAS  Article  Google Scholar 

  • Mazur, D. J., & Merz, J. F. (1994). Patients’ interpretations of verbal expressions of probability: Implications for securing informed consent to medical interventions. Behav Sci Law, 12, 417–426.

    CAS  Article  Google Scholar 

  • Meiser, B., Butow, P., Barratt, A., Suthers, G., Smith, M., Colley, A., et al. (2000). Attitudes to genetic testing for breast cancer susceptibility in women at increased risk developing hereditary breast cancer. J Med Genet, 37, 472–476.

    CAS  Article  Google Scholar 

  • O’Doherty, K. (2005). Risk communication in familial cancer: The discursive management of uncertainty in genetic counseling. Unpublished PhD, The University of Adelaide, Adelaide.

  • O’Doherty, K. (2006). Risk communication in genetic counseling: A discursive approach to probability. Theor Psychol, 16(2), 225–256.

    Article  Google Scholar 

  • Parry, C. (2003). Embracing uncertainty: An exploration of the experiences of childhood cancer survivors. Qual Health Res, 13(1), 227–246.

    Article  Google Scholar 

  • Parsons, E., & Atkinson, P. (1992). Lay constructions of genetic risk. Sociol Health Illness, 14(4), 437–455.

    Article  Google Scholar 

  • Rothman, A. J., & Kiviniemi, M. T. (1999). Treating people with information: an analysis and review of approaches to communicating health risk information. J Nat Can Inst Mono, 25, 44–51.

    Article  Google Scholar 

  • Skolbekken, J.-A. (1998). Communicating the risk reduction achieved by cholesterol reducing drugs. Br Med J, 316(7149), 1956–1959.

    CAS  Article  Google Scholar 

  • Slaytor, E. K., & Ward, J. E. (1998). How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets. Br Med J, 317, 263–264.

    CAS  Article  Google Scholar 

  • Slovic, P. (1987). Perception of risk. Science, 236, 280–286.

    CAS  Article  Google Scholar 

  • Slovic, P., Fischhoff, B., & Lichtenstein, S. (1982). Facts versus fears: Understanding perceived risk. In D. Kahneman, P. Slovic & A. Tversky (Eds.), Judgment under uncertainty: Heuristics and biases. Cambridge: Cambridge University Press.

    Google Scholar 

  • Smits, T., & Hoorens, V. (2005). How probable is probably ? It depends on whom you’re talking about. J Behav Dec Mak, 18, 83–96.

    Article  Google Scholar 

  • Stoddard, J. E., & Fern, E. F. (2002). Buying group choice: The effect of individual group member's prior decision frame. Psychol Mark, 19 (1), 59–90.

    Article  Google Scholar 

  • Theil, M. (2002). The role of translations of verbal into numerical probability expressions: A meta-analysis. J Risk Res, 5(2), 177–186.

    Article  Google Scholar 

  • Trevena, L., Davey, H., Barratt, A., Butow, P., & Caldwell, P. (2006). A systematic review on communicating with patients about evidence. J Evaluat Clin Prac, 12(1), 13–23.

    Article  Google Scholar 

  • Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453–458.

    CAS  Article  Google Scholar 

  • Viscusi, W. K., & Hakes, J. K. (2003). Risk ratings that do not measure probabilities. J Risk Res, 6(1), 23–43.

    Article  Google Scholar 

  • Watson, M., Lloyd, S., Davidson, J., Meyer, L., Eeles, R., Ebbs, S., et al. (1999). The impact of genetic counseling on risk perception and mental health in women with a family history of breast cancer. Br J Can, 79(5/6), 868–874.

    CAS  Article  Google Scholar 

  • Weinstein, N. D. (1999). What does it mean to understand a Risk? Evaluating Risk Comprehension. J Nat Can Inst Mono, 25, 15–20.

    Article  Google Scholar 

  • Weinstein, N., Atwood, K., Puleo, E., Fletcher, R., & Colditz, G. (2004). Colon cancer: Risk perceptions and risk communication. J Health Commun, 9(1), 53–66.

    Article  Google Scholar 

  • Welkenhuysen, M., Evers-Kiebooms, G., & d’Ydewalle, G. (2001). The language of uncertainty in genetic communication: Framing and verbal versus numerical information. Patient Educ Counsel, 43, 179–187.

    CAS  Article  Google Scholar 

  • Wieand, S. H. (2003). Is relative risk reduction a useful measure for patients of families who must choose a method of treatment? J Clin Oncol, 21(23), 4263–4264.

    Article  Google Scholar 

  • Wood, F., Prior, L., & Gray, J. (2003). Translations of risk: Decision making in a cancer genetics service. Health, Risk Soc, 5(2), 185–198.

    Article  Google Scholar 

  • Yates, F. J. (1990). Judgment and decision making. Englewood Cliffs, New Jersey: Prentice Hall.

    Google Scholar 

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ACKNOWLEDGMENTS

We thank Debbie Trott, Jacquie Armstrong, Sally Russell, Vanessa Huntley, Nicola Poplawski, and Matthew Welsh for their support, insight, and suggestions. We also acknowledge the valuable critiques provided by two anonymous reviewers.

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Correspondence to K. O’Doherty.

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O’Doherty, K., Suthers, G.K. Risky Communication: Pitfalls in Counseling About Risk, and How to Avoid Them. J Genet Counsel 16, 409–417 (2007). https://doi.org/10.1007/s10897-006-9077-9

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  • DOI: https://doi.org/10.1007/s10897-006-9077-9

KEY WORDS:

  • Genetic counseling
  • risk
  • familial cancer
  • risk communication