title: Inaccurate risk perceptions and individualized risk estimates by patients with type 2 diabetes.
abstract: BACKGROUND
  We evaluated how diabetic patients understand and respond to the presentation of personalized risk information.
  
  
  METHODS
  This was a mixed methods study involving 56 patients with type 2 diabetes and at least 1 additional cardiovascular risk factor. We assessed participants' perceptions of diabetes-related risks; asked them to rank order 6 events (death, heart attack, stroke, blindness, amputation, and kidney failure) by likelihood of occurrence in a specified time frame; presented them with personalized risk estimates; and asked them to re-rank the risks. The final 18 participants were tested to verify understanding before re-ranking risks. Qualitative analysis of interview transcripts identified themes and concepts underlying participants' ways of perceiving and reacting to risk.
  
  
  RESULTS
  While mortality was the most likely outcome for almost all participants, nearly all estimated it to be least likely; only 28% adjusted their mortality rankings to match model predictions. Some did not understand the risk information: only two thirds of those asked could rank risks according to the information presented. Risk perceptions were influenced by factors including "knowing myself," powerful anecdotes, and belief that a "warning shot" would occur before death.
  
  
  CONCLUSIONS
  Personalized risk estimates, particularly about mortality, had limited salience. Some participants could not understand the information, despite presentation in ways suggested by previous research.
authors.affiliation: From the Department of Family Medicine and Community Health (BGS, JLH, MH), and the Meyers Primary Care Institute (BGS, KMM), University of Massachusetts Medical School, Worcester. Barry.Saver@umassmed.edu.
authors.forename: Barry G
authors.initials: BG
authors.lastname: Saver
authors.affiliation: From the Department of Family Medicine and Community Health (BGS, JLH, MH), and the Meyers Primary Care Institute (BGS, KMM), University of Massachusetts Medical School, Worcester.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.affiliation: From the Department of Family Medicine and Community Health (BGS, JLH, MH), and the Meyers Primary Care Institute (BGS, KMM), University of Massachusetts Medical School, Worcester.
authors.forename: J Lee
authors.initials: JL
authors.lastname: Hargraves
authors.affiliation: From the Department of Family Medicine and Community Health (BGS, JLH, MH), and the Meyers Primary Care Institute (BGS, KMM), University of Massachusetts Medical School, Worcester.
authors.forename: Marcela
authors.initials: M
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D040242:Risk Reduction Behavior
keywords: Communication; Decision Making; Risk; Type 2 Diabetes Mellitus