When counseling patients on genetic risk, consider their motivation for testing and their likelihood of recalling the information.^1,2 Use plain language, absolute risks (instead of relative risks or number to treat), visual aids, careful use of language, and avoid presenting unnecessary information. Present the magnitude and time frame of risk and reinforce the time interval. Order matters when presenting risks and benefits. People perceive risks as more significant when they are presented after the benefits. This is called the recency bias.³ After requesting a test, patients should be offered the option to proceed with disclosure, delay disclosure, or decline disclosure.⁴ Consider the implications of genetic testing for the patient and their family members. Depending on their outlook and test results, patients may interpret their genotype with a feeling of fatalism or reassurance. This could result in a de-prioritization of preventative health care and a decrease in risk-reducing behaviors. If patients learn they are homozygous ApoE4E4, this has implications for their parents and their children (they must each be at least heterozygous ApoE4).

References:
1. Eckert SL et al. Genet Med. 2006;8:746-751.
2. Roberts JS et al. Alzheimer Dis Assoc Disord. 2003;17:86-93.
3. Fagerlin A et al. J Natl Cancer Inst. 2011;103:1436-1443.
4. Langlois CM et al. Alzheimers Dement (N Y). 2019;5:705-716.