title: Evaluating acceptance and understanding of risk in the emergency department: are all risk statements created equally?
abstract: OBJECTIVE
  To determine whether mathematically equivalent but conceptually different presentations of risk from radioactive isotope exposure might affect the rate of agreement to participate in a hypothetical research study.
  
  
  METHODS
  This was a prospective study of consenting English-speaking subjects more than 18 years of age who were asked whether they would agree to participate in a mock study when presented with six mathematically equivalent statements of research-related risk. Participants were classified as recognizing the equivalence of the risk statements if they accepted all or refused all of the risk statements.
  
  
  RESULTS
  Three hundred forty-six subjects were enrolled. There were 55 subjects (16%; 95% CI = 12% to 20%) who refused all of the six risk statements, and 23 participants (6.7%; 95% CI = 4% to 9%) who accepted all of the given risk statements. Most of the participants (77%; 95% CI = 73% to 82%) did not recognize that the six risk statements were equivalent and agreed to some, or did not understand some of the risk statements. In stepwise multivariate logistic regression, being white, being of older age, and having higher education were associated with a higher likelihood of accepting or rejecting all six of the risk statements.
  
  
  CONCLUSIONS
  Ethnicity, age, and education affected whether patients recognized the equivalence of six risk statements for a hypothetical study of low-dose radiation. Risk acceptance may be more likely when familiar concepts are used to express research risks. Researchers must focus on strategies that enhance the understanding of research risks and address the reasons for nonparticipation by subjects who are younger, of different ethnic or cultural background, or of lower education.
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. jfeldman@bu.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Feldman
authors.forename: Michael
authors.initials: M
authors.lastname: Risbano
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Mitchell
authors.forename: Supriya D
authors.initials: SD
authors.lastname: Metha
authors.forename: Susan S
authors.initials: SS
authors.lastname: Fish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006805:Human Experimentation; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D011868:Radioisotopes; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012959:Socioeconomic Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D011868:Radioisotopes; D019275:Radiopharmaceuticals