2011 HSR&D National Meeting Abstract
1024 — Mutations vs. Risk vs. Score: The Format of Genetic Test Results Can Alter Patients’ Reactions and Risk Perceptions
Zikmund-Fisher BJ (University of Michigan School of Public Health), Exe NL
(Center for Bioethics and Social Sciences in Medicine), Lipkus IM
(Duke University), Roberts JS
(University of Michigan), Tarini BA
(University of Michigan), Knight SJ
(VA San Fransisco Healthcare System), Saini SD
(VA Ann Arbor Healthcare System), Schoenfeld PS
(VA Ann Arbor Healthcare System), Tremblay AS
(VA Ann Arbor Healthcare System), Fagerlin A
(VA Ann Arbor Healthcare System)
Advances in genetics are leading towards tests that could be used in primary care to tailor cancer screening regimens to each individual’s personal risk. However, it is unclear how best to communicate such test results. We are conducting the first of a series of experimental tests of patient reactions to possible test result presentation formats.
We surveyed 500 veterans, family and friends recruited from the Ann Arbor VA Primary Care clinic waiting area. Participants read about a hypothetical genetic screening test for colorectal cancer risk. We randomly varied (in a 2x3 factorial design) two factors. First, participants either only learned about genetic determinants of colon cancer risk or also learned about other risk factors (e.g., physical inactivity). Second, we presented test results to participants in one of three ways: 1) a table of genetic mutations (“genetic types”), 2) a risk percentage shown numerically and graphically, or 3) a risk score on an arbitrary 1-10 scale. We assessed participants’ concern about the risk as well as knowledge and perceptions.
Participants who learned about both genetic and other risk factors were more interested in testing than those who only read about genetic risk (p = 0.02). Veterans were less worried (p < 0.01) and thought they had a lower likelihood of colon cancer (p < 0.01) when they saw test results as a risk percentage versus a table of genetic types or a risk score. People who viewed a table of genetic mutations were more likely to think that the test result meant that they would definitely get colon cancer in the future (p = 0.04), while those who saw a risk score thought the results were somewhat less scientific (p = 0.07).
How genetic test results are reported can alter patients’ understanding, risk perceptions, and feelings about the test. Physician communication about other risk factors for colon cancer may increase interest in genetic testing. More research is needed to better understand how communication formats will influence the effectiveness of genetic screening tests.
Identification of patient interpretations of predictive genetic tests may help to guide implementation of genetic testing initiatives within VA.