Gurmankin AD et al. (2005) Patients' resistance to risk information in genetic counseling for BRCA1/2. Arch Intern Med 165: 523–529

Patients' misunderstanding of risk can lead to inappropriate treatment decisions and unnecessarily high levels of distress. It is therefore important to understand how patients perceive the risk information that is provided to them. To examine this question, Gurmankin and colleagues have studied changes in risk perception among women receiving genetic counseling about the risks of breast cancer and BRCA1/2 mutations.

The study included 108 women who attended the Breast and Ovarian Cancer Risk Evaluation Program at the University of Pennsylvania. Having completed a precounseling questionnaire, participants received individualized information, both from a physician and from a genetic counselor, regarding their breast cancer and BRCA1/2 mutation risks. This was followed during the next week by a postcounseling telephone interview, which sought to determine the new perceived risk, recall of the risk information that had been provided, and the associated degree of worry, along with trait anxiety and dispositional optimism.

Although patients' perceived risk of breast cancer and BRCA1/2 mutation were significantly lower after genetic counseling than before, risk perception remained inappropriately high relative to the actual risk information provided. This apparent resistance to risk information was related to both the patients' recall of and their belief in the information. In the case of breast cancer risk, patients' overestimation of their risk was significantly associated with their precounseling worry.

Gurmankin et al. propose that similar studies in other disease areas are indicated. They draw attention to the need for specific interventions to close the communication gap between health-care providers and their patients, with a focus on especially worried patients.