title: How risk is perceived, constructed and interpreted by clients in clinical genetics, and the effects on decision making: systematic review.
abstract: As an individual's understanding of their genetic risk may influence risk management decisions, it is important to understand the ways in which risk is constructed and interpreted. We systematically reviewed the literature, undertaking a narrative synthesis of 59 studies presenting data on the ways in which individuals perceive, construct and interpret their risk, and the subsequent effects. While most studies assessed perceived risk quantitatively, the combined evidence suggests individuals find risk difficult to accurately quantify, with a tendency to overestimate. Rather than being a stand-alone concept, risk is something lived and experienced and the process of constructing risk is complex and influenced by many factors. While evidence of the effects of perceived risk is limited and inconsistent, there is some evidence to suggest high risk estimations may adversely affect health and lead to inappropriate uptake of medical surveillance and preventative measures by some individuals. A more focused approach to research is needed with greater exploration of the ways in which risk is constructed, along with the development of stronger theoretical models, to facilitate effective and patient-centered counseling strategies.
authors.affiliation: Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK. SivellS2@cardiff.ac.uk
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sivell
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Clara L
authors.initials: CL
authors.lastname: Gaff
authors.forename: Angus J
authors.initials: AJ
authors.lastname: Clarke
authors.forename: Rachel
authors.initials: R
authors.lastname: Iredale
authors.forename: Chris
authors.initials: C
authors.lastname: Shaw
authors.forename: Joanna
authors.initials: J
authors.lastname: Dundon
authors.forename: Hazel
authors.initials: H
authors.lastname: Thornton
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
mesh_terms: D003657:Decision Making; D005826:Genetics, Medical; D006801:Humans; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology*; D018570:Risk Assessment