Abstract and Background
Background: Breast 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.
Methods: We 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.
Results: Of 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).
Conclusion: Breast 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.
A patient's knowledge of risks and benefits is crucial to informed decision making. A woman's understanding of her breast cancer risk is, therefore, potentially important in her choice of breast cancer screening options or risk-reduction strategies. The ability to clearly and accurately convey the estimate of breast cancer risk is a vital component of patient education that can enable a woman to make an informed decision. Previous studies have shown that women tend to overestimate their risk of breast cancer.[2,3] To decrease such misinterpretations of risk, it is imperative that women be presented information regarding their estimated risk of breast cancer in an understandable format tailored to their level of understanding.
In a report on risk communication, Lipkus and Hollands showed that visual displays enhance the understanding of numerical risk. Furthermore, in a qualitative study using focus groups, women preferred a frequency format diagram to probability estimates for communicating risk estimates. A review of the literature addressing the efficacy of breast cancer risk communication showed that, of several modalities used to communicate risk, no single modality was the most efficacious. In a study assessing which formats are most accurately perceived by patients, Feldman-Stewart et al reported that, for making a choice, systematic ovals, bars (horizontal or vertical), and numbers were equally well perceived, whereas for estimating magnitude of risk, numbers led to the most accurate estimates. Bogardus and colleagues emphasized the importance of research for ascertaining the best techniques to communicate risks in the clinical setting. Although several studies have analyzed risk communication, few have been randomized trials, and none, to our knowledge, have been randomized trials comparing the efficacy of specific formats of communicating risk among women at high risk for breast cancer.
We conducted a prospective, randomized trial to compare communication of breast cancer risk using a bar graph (standard of care) versus the bar graph in addition to a frequency format diagram (using highlighted human figures) among women at increased risk of breast cancer. The aim of this study was to determine whether patient education regarding breast cancer risk using a bar graph alone or with the addition of a frequency format diagram improved the accuracy of risk perception and to assess women's preference for risk information provided as a bar graph versus in a frequency format.