Inaccurate risk perceptions and individualized risk estimates by patients with type 2 diabetes

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.