Visual Representations of Risk Enhance Long-Term Retention of Risk Information: A Randomized Trial

Abstract

Background. People often overestimate their risk of developing cancer, which can cause undue worry and unwarranted risk-reducing actions. Standard counseling has a limited and short-lived effect on correcting these misperceptions. We conducted a randomized study to evaluate whether incorporation of visual depictions of risk improves the efficacy and durability of cancer risk counseling. Methods. Sixty-six individuals seen in the Familial Cancer Program were randomized to receive standard counseling or counseling supplemented with 2 interactive visual representations of their 10-year risk of developing the cancer type of greatest concern (enhanced counseling). The primary outcome was accuracy of self-perceived risk (ratio of perceived to objective risk) 2 weeks and 6 months after counseling. Results. Prior to counseling, 80% of participants overestimated their risk. Improvement in self-perception of risk was greater among those individuals randomized to receive enhanced counseling. At the 2-week follow-up, the percentage of participants who continued to overestimate their risk by 5-fold or more was 3 to 4 times lower in those who received enhanced counseling, compared to the standard counseling group. At the 6-month follow-up, sustained improvement in risk perception was most evident among those exposed to visual depictions of their risk. Statistical significance was achieved in chi-square analysis at P < 0.05, grouping participants’ risk estimate as approximately accurate (<2-fold) or different from objective risk to varying degrees. Conclusions. Overestimation of cancer risk among people with a family history of cancer is common. Counseling can improve risk perception, but individuals tend to revert back to their prior misperception 6 months after counseling. By including visual representations of risk during counseling, correction of risk perception was of greater magnitude and more durable.