Evaluating acceptance and understanding of risk in the emergency department: are all risk statements created equally?

To determine whether mathematically equivalent but conceptually different presentations of risk from radioactive isotope exposure might affect the rate of agreement to participate in a hypothetical research study.

This was a prospective study of consenting English-speaking subjects more than 18 years of age who were asked whether they would agree to participate in a mock study when presented with six mathematically equivalent statements of research-related risk. Participants were classified as recognizing the equivalence of the risk statements if they accepted all or refused all of the risk statements.

Three hundred forty-six subjects were enrolled. There were 55 subjects (16%; 95% CI = 12% to 20%) who refused all of the six risk statements, and 23 participants (6.7%; 95% CI = 4% to 9%) who accepted all of the given risk statements. Most of the participants (77%; 95% CI = 73% to 82%) did not recognize that the six risk statements were equivalent and agreed to some, or did not understand some of the risk statements. In stepwise multivariate logistic regression, being white, being of older age, and having higher education were associated with a higher likelihood of accepting or rejecting all six of the risk statements.

Ethnicity, age, and education affected whether patients recognized the equivalence of six risk statements for a hypothetical study of low-dose radiation. Risk acceptance may be more likely when familiar concepts are used to express research risks. Researchers must focus on strategies that enhance the understanding of research risks and address the reasons for nonparticipation by subjects who are younger, of different ethnic or cultural background, or of lower education.