Open Access Open Badges Research article

The effectiveness of a graphical presentation in addition to a frequency format in the context of familial breast cancer risk communication: a multicenter controlled trial

Lidewij Henneman14*, Jan C Oosterwijk2, Christi J van Asperen3, Fred H Menko4, Caroline F Ockhuysen-Vermey1, Piet J Kostense5, Liesbeth Claassen1 and Daniëlle RM Timmermans1

Author Affiliations

1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

2 Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

3 Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands

4 Department of Clinical Genetics, section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

5 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

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BMC Medical Informatics and Decision Making 2013, 13:55  doi:10.1186/1472-6947-13-55

Published: 29 April 2013



Inadequate understanding of risk among counselees is a common problem in familial cancer clinics. It has been suggested that graphical displays can help counselees understand cancer risks and subsequent decision-making. We evaluated the effects of a graphical presentation in addition to a frequency format on counselees’ understanding, psychological well-being, and preventive intentions.

Design: Multicenter controlled trial.

Setting: Three familial cancer clinics in the Netherlands.


Participants: Unaffected women with a breast cancer family history (first-time attendees).

Intervention: Immediately after standard genetic counseling, an additional consultation by a trained risk counselor took place where women were presented with their lifetime breast cancer risk in frequency format (X out of 100) (n = 63) or frequency format plus graphical display (10 × 10 human icons) (n = 91).

Main outcome measures: understanding of risk (risk accuracy, risk perception), psychological well-being, and intentions regarding cancer prevention. Measurements were assessed using questionnaires at baseline, 2-week and 6-month follow-up.


Baseline participant characteristics did not differ between the two groups. In both groups there was an increase in women’s risk accuracy from baseline to follow-up. No significant differences were found between women who received the frequency format and those who received an additional graphical display in terms of understanding, psychological well-being and intentions regarding cancer prevention. The groups did not differ in their evaluation of the process of counseling.


Women’s personal risk estimation accuracy was generally high at baseline and the results suggest that an additional graphical display does not lead to a significant benefit in terms of increasing understanding of risk, psychological well-being and preventive intentions.

Trial registration

Current Controlled Trials http://ISRCTN14566836 webcite

Breast cancer; Genetic counseling; Risk communication; Risk perception; Cancer worry; Decision-making; Graphical display