Communication of Uncertainty Regarding Individualized Cancer Risk Estimates

Han, Paul K. J.; Klein, William M. P.; Lehman, Tom; Killam, Bill; Massett, Holly A.; Freedman, Andrew

doi:10.1177/0272989x10371830

Cited by 111 publications

(138 citation statements)

References 44 publications

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“…23,31,[34][35][36] However, care should be taken when selecting a specific visual format because such a presentation could influence risk interpretation and trigger an emotional response. 37 As observed during our focus group sessions, the use of non-tailored strategies can generate reassurance, worry or doubt. Nonetheless, the use of formats that prompt anxiety and fear may be justified in certain contexts, such as mass public health communication.…”

Section: Discussionmentioning

confidence: 86%

A focus group study on breast cancer risk presentation: one format does not fit all

et al. 2012

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Identifying a strategy that would optimize both the communication and understanding of the individual breast cancer risk remains a considerable challenge. This study explored the preferences of women with a family history of breast cancer about six presentation formats of individual breast cancer risk, as calculated from a risk prediction model. Thirty-four unaffected women attending genetic counseling because of a family history of breast cancer participated in six focus groups conducted in Qué bec City (2), Montré al (2) and Toronto (2), Canada. Six risk formats were presented for a fictitious case involving a 35-year-old woman (1-numerical: cumulative risk probabilities by age until 80 years; 2-risk curves: probabilities expressed in a risk curve that also provided a risk curve for a woman with no family history in first-degree relatives; 3-relative risk of breast cancer by age 80 years; 4 and 5-absolute risk of breast cancer and absolute chance of not developing breast cancer in the next 20 years; 6-qualitative: color-coded figure). Participants were asked to indicate their appreciation of each format. A group discussion followed during which participants commented on each format. The most and least appreciated formats were risk curves and relative risk, respectively. Overall, participants advocated the use of formats that combine quantitative, qualitative and visual features. Using a combination of approaches to communicate individual breast cancer risks could be associated with higher satisfaction of counselees. Given the increasing use of risk prediction models, it may be relevant to consider the preferences of both the counselee and the professional.

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Section: Discussionmentioning

confidence: 86%

A focus group study on breast cancer risk presentation: one format does not fit all

et al. 2012

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“…In a previous study that sought to communicate colorectal cancer risk, imprecision was conveyed with both text and visual formats. Although presenting a numeric range around a point estimate increased cancer worry, the effect was mitigated when a visual representation was used to indicate uncertainty (29). In a study of the communication of patient-reported outcomes, six graphic formats were used to present data, including one format of line graphs with CIs; although clinicians valued the CIs, patients found them to be confusing (19).…”

Section: Discussionmentioning

confidence: 99%

How Patients View Lung Cancer Screening. The Role of Uncertainty in Medical Decision Making

Schapira

Aggarwal

Akers³

et al. 2016

Annals ATS

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Rationale: Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision-making process. Guidance is needed regarding how to conduct shared decision making effectively. A useful organizing theme should include consideration of a patient's response to and tolerance of uncertainty associated with lung cancer screening.Objectives: The objectives of this study are to: (1) describe how patients respond to specific categories of uncertainty in the context of lung cancer screening, and (2) inform strategies for addressing concerns about uncertainty as part of the shared decision making.Methods: We performed two series of structured interviews on participants in a convenience sample of current or former cigarette smokers recruited from primary care and pulmonary practices in Philadelphia. An interview guide included prompts related to benefits, harms, and responses to general and specific types of uncertainty (stochastic, statistical, and evidentiary) associated with lung cancer screening. Interviews were audio-recorded, transcribed, and independently coded by two investigators. An inductive analysis was conducted, and major themes were identified.Measurements and Main Results: Twenty-two adults participated in the study. Sixty-eight percent were men, 72% were black or African American, and 50% met U.S. Preventive Services Task Force criteria for lung cancer screening. The primary themes to emerge from our study were: (1) the desire to decrease uncertainty may motivate lung cancer screening decisions; (2) uncertainty is an attribute of health states that impacts how patients weigh benefits and harms of lung cancer screening; (3) patient understanding and tolerance of uncertainty varies across stochastic, statistical, and evidentiary uncertainty; and (4) provider-patient communication may mitigate intolerance of uncertainty in the context of lung cancer screening. Conclusions:A systematic approach to understanding and addressing patients' concerns about uncertainty in the context of lung cancer screening can guide a patient-centered approach to shared decision making. The results of this study can inform provider-patient communication strategies regarding the decision to perform radiographic lung cancer screening.

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“…Perhaps doctors also fear that disclosing the uncertainty about the natural history of DCIS may affect patients' willingness to have treatment. The impact of communicating various types of uncertainty on patients has been shown to vary according to patients' cognitive, emotional and behavioural characteristics [37,39,40]. Further research is needed to assess patients' and doctors' responses to the uncertainty involved in DCIS, how to increase patients' tolerance to uncertainty and how to tailor communication about uncertainty to individual patients.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS)

Morgan

Redman

DʼEste

et al. 2011

Patient Education and Counseling

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Communication of Uncertainty Regarding Individualized Cancer Risk Estimates

Cited by 111 publications

References 44 publications

A focus group study on breast cancer risk presentation: one format does not fit all

A focus group study on breast cancer risk presentation: one format does not fit all

How Patients View Lung Cancer Screening. The Role of Uncertainty in Medical Decision Making

Knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS)

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