Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma

Abstract

Background: Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors.

Purpose: To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later.

Methods: A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling.

Results: Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling.

Conclusions: Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.

Keywords: Genetic counseling; Genetic testing; Melanoma; Perceived risk; Priority of risk; Sun protection.

Fig. 1.

Changes in multiple components of risk perceptions as a function of genetic counseling and test reporting (p16 carriers and noncarriers) versus counseling based on family history alone (no-test controls). Means in all analyses are evaluated at the mean of propensity scores. The 12-month assessment occurred 12 months after counseling. Y-axes are truncated for ease of interpretation. * indicates significant (p < .05) change from baseline to the selected post-counseling assessment for carriers (+), noncarriers (−), and no-test controls (ntc).