TY - JOUR
T1 - Prevalence and alternative explanations influence cancer diagnosis
T2 - An experimental study with physicians
AU - Sirota, Miroslav
AU - Kostopoulou, Olga
AU - Round, Thomas
AU - Samaranayaka, Shyamalee
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Objective: Cancer causes death to millions of people worldwide. Early detection of cancer in primary care may enhance patients' chances of survival. However, physicians often miss early cancers, which tend to present with undifferentiated symptoms. Within a theoretical framework of the hypothesis generation (HyGene) model, together with psychological literature, we studied how 2 factors- cancer prevalence and an alternative explanation for the patient's symptoms-impede early cancer detection, as well as prompt patient management. Method: Three hundred family physicians diagnosed and managed 2 patient cases, where cancer was a possible diagnosis (one colorectal cancer, the other lung cancer). We employed a 2 (cancer prevalence: low vs. high) × 2 (alternative explanation: present vs. absent) between-subjects design. Cancer prevalence was manipulated by changing either patient age or sex; the alternative explanation for the symptoms was manipulated by adding or removing a relevant clinical history. Each patient consulted twice. Results: In a series of random-intercept logistic models, both higher prevalence (OR = 1.92, 95% confidence interval [CI 1.27, 2.92]) and absence of an alternative explanation (OR = 1.70, 95% CI [1.11, 2.59]) increased the likelihood of a cancer diagnosis, which, in turn, increased the likelihood of prompt referral (OR = 22.84, 95% CI [16.14, 32.32]). Conclusions: These findings confirm the probabilistic nature of the diagnosis generation process and validate the application of the HyGene model to early cancer detection. Increasing the salience of cancer-such as listing cancer as a diagnostic possibility- during the initial hypothesis generation phase may improve early cancer detection.
AB - Objective: Cancer causes death to millions of people worldwide. Early detection of cancer in primary care may enhance patients' chances of survival. However, physicians often miss early cancers, which tend to present with undifferentiated symptoms. Within a theoretical framework of the hypothesis generation (HyGene) model, together with psychological literature, we studied how 2 factors- cancer prevalence and an alternative explanation for the patient's symptoms-impede early cancer detection, as well as prompt patient management. Method: Three hundred family physicians diagnosed and managed 2 patient cases, where cancer was a possible diagnosis (one colorectal cancer, the other lung cancer). We employed a 2 (cancer prevalence: low vs. high) × 2 (alternative explanation: present vs. absent) between-subjects design. Cancer prevalence was manipulated by changing either patient age or sex; the alternative explanation for the symptoms was manipulated by adding or removing a relevant clinical history. Each patient consulted twice. Results: In a series of random-intercept logistic models, both higher prevalence (OR = 1.92, 95% confidence interval [CI 1.27, 2.92]) and absence of an alternative explanation (OR = 1.70, 95% CI [1.11, 2.59]) increased the likelihood of a cancer diagnosis, which, in turn, increased the likelihood of prompt referral (OR = 22.84, 95% CI [16.14, 32.32]). Conclusions: These findings confirm the probabilistic nature of the diagnosis generation process and validate the application of the HyGene model to early cancer detection. Increasing the salience of cancer-such as listing cancer as a diagnostic possibility- during the initial hypothesis generation phase may improve early cancer detection.
KW - Alternative explanation
KW - Cancer diagnosis
KW - Diagnostic reasoning
KW - Diagnostic support
KW - Prevalence
UR - http://www.scopus.com/inward/record.url?scp=85013786368&partnerID=8YFLogxK
U2 - 10.1037/hea0000461
DO - 10.1037/hea0000461
M3 - Article
AN - SCOPUS:85013786368
SN - 0278-6133
VL - 36
SP - 477
EP - 485
JO - Health psychology : official journal of the Division of Health Psychology, American Psychological Association
JF - Health psychology : official journal of the Division of Health Psychology, American Psychological Association
IS - 5
ER -