The influence of disease severity of preceding clinical cases on pathologists' medical decision making

Paul D. Frederick, Heidi Nelson, Patricia (Patty) Carney, Tad T. Brunyé, Kimberly H. Allison, Donald L. Weaver, Joann G. Elmore

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. Medical decision making may be influenced by contextual factors. We evaluated whether pathologists are influenced by disease severity of recently observed cases. Methods. Pathologists independently interpreted 60 breast biopsy specimens (one slide per case; 240 total cases in the study) in a prospective randomized observational study. Pathologists interpreted the same cases in 2 phases, separated by a washout period of >6 months. Participants were not informed that the cases were identical in each phase, and the sequence was reordered randomly for each pathologist and between phases. A consensus reference diagnosis was established for each case by 3 experienced breast pathologists. Ordered logit models examined the effect the pathologists' diagnoses on the preceding case or the 5 preceding cases had on their diagnosis for the subsequent index case. Results. Among 152 pathologists, 49 provided interpretive data in both phases I and II, 66 from only phase I, and 37 from phase II only. In phase I, pathologists were more likely to indicate a more severe diagnosis than the reference diagnosis when the preceding case was diagnosed as ductal carcinoma in situ (DCIS) or invasive cancer (proportional odds ratio [POR], 1.28; 95% confidence interval [CI], 1.15-1.42). Results were similar when considering the preceding 5 cases and for the pathologists in phase II who interpreted the same cases in a different order compared with phase I (POR, 1.17; 95% CI, 1.05-1.31). Conclusion. Physicians appear to be influenced by the severity of previously interpreted test cases. Understanding types and sources of diagnostic bias may lead to improved assessment of accuracy and better patient care.

Original languageEnglish (US)
Pages (from-to)91-100
Number of pages10
JournalMedical Decision Making
Volume37
Issue number1
DOIs
StatePublished - 2017

Fingerprint

Breast
Odds Ratio
Confidence Intervals
Pathologists
Clinical Decision-Making
Carcinoma, Intraductal, Noninfiltrating
Observational Studies
Patient Care
Logistic Models
Physicians
Biopsy
Neoplasms

Keywords

  • Bias
  • Biopsy
  • Breast
  • Cancer
  • Diagnosis
  • Interpretation
  • Sequential context effects

ASJC Scopus subject areas

  • Health Policy

Cite this

The influence of disease severity of preceding clinical cases on pathologists' medical decision making. / Frederick, Paul D.; Nelson, Heidi; Carney, Patricia (Patty); Brunyé, Tad T.; Allison, Kimberly H.; Weaver, Donald L.; Elmore, Joann G.

In: Medical Decision Making, Vol. 37, No. 1, 2017, p. 91-100.

Research output: Contribution to journalArticle

Frederick, Paul D. ; Nelson, Heidi ; Carney, Patricia (Patty) ; Brunyé, Tad T. ; Allison, Kimberly H. ; Weaver, Donald L. ; Elmore, Joann G. / The influence of disease severity of preceding clinical cases on pathologists' medical decision making. In: Medical Decision Making. 2017 ; Vol. 37, No. 1. pp. 91-100.
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abstract = "Background. Medical decision making may be influenced by contextual factors. We evaluated whether pathologists are influenced by disease severity of recently observed cases. Methods. Pathologists independently interpreted 60 breast biopsy specimens (one slide per case; 240 total cases in the study) in a prospective randomized observational study. Pathologists interpreted the same cases in 2 phases, separated by a washout period of >6 months. Participants were not informed that the cases were identical in each phase, and the sequence was reordered randomly for each pathologist and between phases. A consensus reference diagnosis was established for each case by 3 experienced breast pathologists. Ordered logit models examined the effect the pathologists' diagnoses on the preceding case or the 5 preceding cases had on their diagnosis for the subsequent index case. Results. Among 152 pathologists, 49 provided interpretive data in both phases I and II, 66 from only phase I, and 37 from phase II only. In phase I, pathologists were more likely to indicate a more severe diagnosis than the reference diagnosis when the preceding case was diagnosed as ductal carcinoma in situ (DCIS) or invasive cancer (proportional odds ratio [POR], 1.28; 95{\%} confidence interval [CI], 1.15-1.42). Results were similar when considering the preceding 5 cases and for the pathologists in phase II who interpreted the same cases in a different order compared with phase I (POR, 1.17; 95{\%} CI, 1.05-1.31). Conclusion. Physicians appear to be influenced by the severity of previously interpreted test cases. Understanding types and sources of diagnostic bias may lead to improved assessment of accuracy and better patient care.",
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