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.
Similar content being viewed by others
REFERENCES
Bernstein, P. L. (1996). Against the gods: The remarkable story of risk. New York: John Wiley & Sons.
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.
Claus, E. B. (2001). Risk models used to counsel women for breast and ovarian cancer: A guide for clinicians. Familial Can, 1, 197–206.
Edwards, A., Elwyn, G., & Mulley, A. (2002). Explaining risks: Turning numerical data into meaningful pictures. Br Med J, 324, 827–830.
Facione, N. C. (2002). Perceived risk of breast cancer: influence of heuristic thinking. Can Prac, 10(5), 256–262.
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.
Gigerenzer, G. (2002). Reckoning with risk: Learning to live with uncertainty. London: Penguin.
Gigerenzer, G., & Edwards, A. (2003). Simple tools for understanding risks: from innumeracy to insight. Br Med J, 327, 741–744.
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.
Hallowell, N. (2000). A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy. Psycho-Oncology, 9, 486–495.
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.
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.
Hodge, S. E. (1998). A simple, unified approach to bayesian risk calculations. J Gen Counsel, 7(3), 235–261.
Jaynes, E. T. (2003). Probability theory: The logic of science. Cambridge: Cambridge University Press.
Johnson, B. B. (2004). Risk comparisons, conflict, and risk acceptability claims. Risk Anal, 24(1), 131–145.
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.
Kahneman, D., & Tversky, A. (1984). Choices, values, and frames. Am Psychol, 39(4), 342–347.
Kahneman, D., & Tversky, A. (Eds.). (2000). Choices, values, and frames. Cambridge: Cambridge University Press.
Kreuter, M. W. (1999). Dealing with competing and conflicting risks in cancer communication. J Nat Can Inst Mono, 25, 27–35.
Kuhn, K. M. (1997). Communicating uncertainty: framing effects on responses to vague probabilities. Organ Behav Hum Dec Proc, 71(1), 55–83.
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.
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.
Lupton, D. (Ed.). (1999). Risk and sociocultural theory. Cambridge: Cambridge University Press.
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.
Marteau, T. M. (1999). Communicating genetic risk information. Br Med Bull, 55(2), 414–428.
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.
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.
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.
Parry, C. (2003). Embracing uncertainty: An exploration of the experiences of childhood cancer survivors. Qual Health Res, 13(1), 227–246.
Parsons, E., & Atkinson, P. (1992). Lay constructions of genetic risk. Sociol Health Illness, 14(4), 437–455.
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.
Skolbekken, J.-A. (1998). Communicating the risk reduction achieved by cholesterol reducing drugs. Br Med J, 316(7149), 1956–1959.
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.
Slovic, P. (1987). Perception of risk. Science, 236, 280–286.
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.
Smits, T., & Hoorens, V. (2005). How probable is probably ? It depends on whom you’re talking about. J Behav Dec Mak, 18, 83–96.
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.
Theil, M. (2002). The role of translations of verbal into numerical probability expressions: A meta-analysis. J Risk Res, 5(2), 177–186.
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.
Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453–458.
Viscusi, W. K., & Hakes, J. K. (2003). Risk ratings that do not measure probabilities. J Risk Res, 6(1), 23–43.
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.
Weinstein, N. D. (1999). What does it mean to understand a Risk? Evaluating Risk Comprehension. J Nat Can Inst Mono, 25, 15–20.
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.
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.
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.
Wood, F., Prior, L., & Gray, J. (2003). Translations of risk: Decision making in a cancer genetics service. Health, Risk Soc, 5(2), 185–198.
Yates, F. J. (1990). Judgment and decision making. Englewood Cliffs, New Jersey: Prentice Hall.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10897-006-9077-9