Communication of uncertainty regarding individualized cancer risk estimates: effects and influential factors.
To examine the effects of communicating uncertainty regarding individualized colorectal cancer risk estimates and to identify factors that influence these effects.



Two Web-based experiments were conducted, in which adults aged 40 years and older were provided with hypothetical individualized colorectal cancer risk estimates differing in the extent and representation of expressed uncertainty. The uncertainty consisted of imprecision (otherwise known as "ambiguity") of the risk estimates and was communicated using different representations of confidence intervals. Experiment 1 (n = 240) tested the effects of ambiguity (confidence interval v. point estimate) and representational format (textual v. visual) on cancer risk perceptions and worry. Potential effect modifiers, including personality type (optimism), numeracy, and the information's perceived credibility, were examined, along with the influence of communicating uncertainty on responses to comparative risk information. Experiment 2 (n = 135) tested enhanced representations of ambiguity that incorporated supplemental textual and visual depictions.



Communicating uncertainty led to heightened cancer-related worry in participants, exemplifying the phenomenon of "ambiguity aversion." This effect was moderated by representational format and dispositional optimism; textual (v. visual) format and low (v. high) optimism were associated with greater ambiguity aversion. However, when enhanced representations were used to communicate uncertainty, textual and visual formats showed similar effects. Both the communication of uncertainty and use of the visual format diminished the influence of comparative risk information on risk perceptions.



The communication of uncertainty regarding cancer risk estimates has complex effects, which include heightening cancer-related worry-consistent with ambiguity aversion-and diminishing the influence of comparative risk information on risk perceptions. These responses are influenced by representational format and personality type, and the influence of format appears to be modifiable and content dependent.
Han
Paul K J
PK
Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine (PKJH)
Klein
William M P
WM
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (WMPK, ANF)
Lehman
Tom
T
Center for Social Marketing and Behavior Change, Academy for Educational Development, Washington, DC (TL)
Killam
Bill
B
User-Centered Design, Ashburn, Virginia (BK)
Massett
Holly
H
Office of Market Research and Evaluation, National Cancer Institute, Bethesda, Maryland (HM)
Freedman
Andrew N
AN
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (WMPK, ANF)
D003142:Communication; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D035501:Uncertainty