Abstract
Background: Cytology often is used to obtain a diagnosis, such as that of malignant neoplasia. When a diagnosis is uncertain, pathologists often express probability using qualitative terms, such as "probable," that have imprecise meanings. Hypothesis: Terms expressing probability are interpreted variably by veterinary practitioners and affect decisions regarding treatment and euthanasia. Animals: None. Methods: An online survey of members of the Veterinary Information Network was conducted. Veterinarians were asked to assign percentage probabilities to 18 modifiers of a diagnosis of lymphoma. They also were asked to select their most likely clinical action based on a diagnosis of lymphoma qualified one of 4 modifiers. Results were analyzed using descriptive and nonparametric methods. Percentage probabilities were analyzed by ANOVA after variance stabilization. Results: For 871 valid surveys, probabilities assigned to the 18 modifiers overlapped substantially, with medians (interquartile range) of 50% (50-70%) for "possible," 66% (66-85%) for "probable," and 70% (70-90%) for "consistent with." More (P < 001) veterinarians (50.4%) chose to initiate treatment with a diagnosis of "consistent with lymphoma" as compared with "probable" (14.6%) or "possible" (1.6%) lymphoma. For clients considering euthanasia if the diagnosis was cancer, more (P < 001) veterinarians recommended euthanasia with a diagnosis of "consistent with lymphoma" (62.5%) as compared with "probable" (35.3%), or "possible" (2.0%) lymphoma. Conclusions and Clinical Importance: Probability expressions are interpreted variably yet have a major impact on clinical decision-making, including the decision to recommend euthanasia. Standardized terminology could improve decision-making and enhance clinical outcome.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 496-503 |
| Number of pages | 8 |
| Journal | Journal of Veterinary Internal Medicine |
| Volume | 24 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 2010 |
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Keywords
- Clinical pathology
- Decision support
- Evidence-based medicine
- Oncology diagnosis
- Uncertainty
ASJC Scopus subject areas
- veterinary(all)
Cite this
Interpretation by clinicians of probability expressions in cytology reports and effect on clinical decision-making. / Christopher, Mary M; Hotz, C. S.; Shelly, S. M.; Pion, P. D.
In: Journal of Veterinary Internal Medicine, Vol. 24, No. 3, 05.2010, p. 496-503.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Interpretation by clinicians of probability expressions in cytology reports and effect on clinical decision-making
AU - Christopher, Mary M
AU - Hotz, C. S.
AU - Shelly, S. M.
AU - Pion, P. D.
PY - 2010/5
Y1 - 2010/5
N2 - Background: Cytology often is used to obtain a diagnosis, such as that of malignant neoplasia. When a diagnosis is uncertain, pathologists often express probability using qualitative terms, such as "probable," that have imprecise meanings. Hypothesis: Terms expressing probability are interpreted variably by veterinary practitioners and affect decisions regarding treatment and euthanasia. Animals: None. Methods: An online survey of members of the Veterinary Information Network was conducted. Veterinarians were asked to assign percentage probabilities to 18 modifiers of a diagnosis of lymphoma. They also were asked to select their most likely clinical action based on a diagnosis of lymphoma qualified one of 4 modifiers. Results were analyzed using descriptive and nonparametric methods. Percentage probabilities were analyzed by ANOVA after variance stabilization. Results: For 871 valid surveys, probabilities assigned to the 18 modifiers overlapped substantially, with medians (interquartile range) of 50% (50-70%) for "possible," 66% (66-85%) for "probable," and 70% (70-90%) for "consistent with." More (P < 001) veterinarians (50.4%) chose to initiate treatment with a diagnosis of "consistent with lymphoma" as compared with "probable" (14.6%) or "possible" (1.6%) lymphoma. For clients considering euthanasia if the diagnosis was cancer, more (P < 001) veterinarians recommended euthanasia with a diagnosis of "consistent with lymphoma" (62.5%) as compared with "probable" (35.3%), or "possible" (2.0%) lymphoma. Conclusions and Clinical Importance: Probability expressions are interpreted variably yet have a major impact on clinical decision-making, including the decision to recommend euthanasia. Standardized terminology could improve decision-making and enhance clinical outcome.
AB - Background: Cytology often is used to obtain a diagnosis, such as that of malignant neoplasia. When a diagnosis is uncertain, pathologists often express probability using qualitative terms, such as "probable," that have imprecise meanings. Hypothesis: Terms expressing probability are interpreted variably by veterinary practitioners and affect decisions regarding treatment and euthanasia. Animals: None. Methods: An online survey of members of the Veterinary Information Network was conducted. Veterinarians were asked to assign percentage probabilities to 18 modifiers of a diagnosis of lymphoma. They also were asked to select their most likely clinical action based on a diagnosis of lymphoma qualified one of 4 modifiers. Results were analyzed using descriptive and nonparametric methods. Percentage probabilities were analyzed by ANOVA after variance stabilization. Results: For 871 valid surveys, probabilities assigned to the 18 modifiers overlapped substantially, with medians (interquartile range) of 50% (50-70%) for "possible," 66% (66-85%) for "probable," and 70% (70-90%) for "consistent with." More (P < 001) veterinarians (50.4%) chose to initiate treatment with a diagnosis of "consistent with lymphoma" as compared with "probable" (14.6%) or "possible" (1.6%) lymphoma. For clients considering euthanasia if the diagnosis was cancer, more (P < 001) veterinarians recommended euthanasia with a diagnosis of "consistent with lymphoma" (62.5%) as compared with "probable" (35.3%), or "possible" (2.0%) lymphoma. Conclusions and Clinical Importance: Probability expressions are interpreted variably yet have a major impact on clinical decision-making, including the decision to recommend euthanasia. Standardized terminology could improve decision-making and enhance clinical outcome.
KW - Clinical pathology
KW - Decision support
KW - Evidence-based medicine
KW - Oncology diagnosis
KW - Uncertainty
UR - http://www.scopus.com/inward/record.url?scp=77954352787&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77954352787&partnerID=8YFLogxK
U2 - 10.1111/j.1939-1676.2010.0492.x
DO - 10.1111/j.1939-1676.2010.0492.x
M3 - Article
C2 - 20337918
AN - SCOPUS:77954352787
VL - 24
SP - 496
EP - 503
JO - Journal of Veterinary Internal Medicine
JF - Journal of Veterinary Internal Medicine
SN - 0891-6640
IS - 3
ER -