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Patients' Understanding of Medical Risks: Implications for Genetic Counseling


Original Research

Objective To assess patients' ability to compare magnitudes of Down syndrome risk at maternal ages of 35 and 40 years, expressed as rates or as proportions.

Methods We used a self-administered, anonymous questionnaire that posed the same comparison in two different formats: 2.6 versus 8.9 per 1000 women (rates) and one in 384 versus one in 112 women (proportions). The study setting included several university-affiliated obstetrics and gynecology outpatient clinics in San Francisco, California. A total of 633 women, whose primary languages were English, Spanish, or Chinese, participated. The main outcome measure was correct identification of the larger of two risks.

Results Women were more successful with rates (463 of 633 respondents, 73%) than with proportions (353 of 633 respondents, 56%). A paired analysis, in which each woman served as her own control, found risk assessment to be significantly better with rates than with proportions (P < .001). Women with little formal education had difficulty understanding risks framed either way.

Conclusion The traditional use of proportions to express risk in genetic counseling lacks scientific basis. Rates were easier to understand than proportions, regardless of respondents' age, language, and education.

Although genetic counseling traditionally has expressed risks as proportions (eg, one in 384), patients understand rates (eg, 2.6 per 1000) better than they do proportions.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, and Family Health International, Research Triangle Park, North Carolina.

Address reprint requests to: David A. Grimes, MD Family Health International PO Box 13950 Research Triangle Park, NC 27709 E-mail:

The Dean's Office, University of California, San Francisco, provided research support to Ms. Snively.

Received September 21, 1998. Received in revised form November 19, 1998. Accepted December 10, 1998.

© 1999 The American College of Obstetricians and Gynecologists