Little is known about how individuals might interpret brief genetic risk feedback. We examined interpretation and behavioral intentions (sun protection, skin screening) in melanoma first-degree relatives (FDRs) after exposure to brief prototypic melanoma risk feedback. Using a 3 by 2 experimental pre-post design where feedback type (high-risk mutation, gene environment, and nongenetic) and risk level (positive versus negative findings) were systematically varied, 139 melanoma FDRs were randomized to receive one of the six scenarios. All scenarios included an explicit reminder that melanoma family history increased their risk regardless of their feedback. The findings indicate main effects by risk level but not feedback type; positive findings led to heightened anticipated melanoma risk perceptions and anticipated behavioral intentions. Yet those who received negative findings often discounted their family melanoma history. As such, 25%, 30%, and 32% of those who received negative mutation, gene-environment, and nongenetic feedback, respectively, reported that their risk was similar to the general population. Given the frequency with which those who pursue genetic testing may receive negative feedback, attention is needed to identify ideal strategies to present negative genetic findings in contexts such as direct to consumer channels where extensive genetic counseling is not required. 1. Background The sequencing of the entire human genome in 2003 has led to a series of unrealized opportunities for public health benefit [1], many of which rest on accurate genetic risk interpretation and adoption of protective behavior [2]. By 2006, direct-to-consumer genetic testing and feedback was available through 24 Internet-based companies, many of which did not require physician or genetic counseling followup to ensure accurate interpretation of test findings [3]. Recent general population surveys indicate high levels of risk misinterpretation even among highly educated general population subgroups [4–6]. To date, the few studies that have examined outcomes associated with direct-to-consumer genetic testing have found no remarkable increases in distress, screening, or behavior change [7–9], yet it is unclear whether these findings may be due to risk misinterpretation, or lack of consideration of diverse elements of risk, including family history. First-degree relatives (FDRs) of cancer patients may be among the first to pursue cancer genetic susceptibility testing through direct-to-consumer channels, given their heightened risk salience [10]. Among FDRs,
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