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Presentation of Diagnostic Information to Doctors May Change Their Interpretation and Clinical Management: A Web-Based Randomised Controlled Trial.

Ben-Shlomo Y, Collin SM, Quekett J, Sterne JA, Whiting P - PLoS ONE (2015)

Bottom Line: Younger age, postgraduate training and higher self-rated confidence all predicted better knowledge performance.Doctors with better knowledge were more likely to view an optional learning tutorial (OR per correct answer 1.18, 95% CI 1.06, 1.31).Presenting diagnostic data using a probability-modifying plot or natural frequency tree influences the threshold for treatment and improves interpretation of tests results compared to text summary of sensitivity and specificity or Fagan's nomogram.

View Article: PubMed Central - PubMed

Affiliation: School of Social & Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom.

ABSTRACT

Background: There is little evidence on how best to present diagnostic information to doctors and whether this makes any difference to clinical management. We undertook a randomised controlled trial to see if different data presentations altered clinicians' decision to further investigate or treat a patient with a fictitious disorder ("Green syndrome") and their ability to determine post-test probability.

Methods: We recruited doctors registered with the United Kingdom's largest online network for medical doctors between 10 July and 6" November 2012. Participants were randomised to one of four arms: (a) text summary of sensitivity and specificity, (b) Fagan's nomogram, (c) probability-modifying plot (PMP), (d) natural frequency tree (NFT). The main outcome measure was the decision whether to treat, not treat or undertake a brain biopsy on the hypothetical patient and the correct post-test probability. Secondary outcome measures included knowledge of diagnostic tests.

Results: 917 participants attempted the survey and complete data were available from 874 (95.3%). Doctors randomized to the PMP and NFT arms were more likely to treat the patient than those randomized to the text-only arm. (ORs 1.49, 95% CI 1.02, 2.16) and 1.43, 95% CI 0.98, 2.08 respectively). More patients randomized to the PMP (87/218-39.9%) and NFT (73/207-35.3%) arms than the nomogram (50/194-25.8%) or text only (30/255-11.8%) arms reported the correct post-test probability (p <0.001). Younger age, postgraduate training and higher self-rated confidence all predicted better knowledge performance. Doctors with better knowledge were more likely to view an optional learning tutorial (OR per correct answer 1.18, 95% CI 1.06, 1.31).

Conclusions: Presenting diagnostic data using a probability-modifying plot or natural frequency tree influences the threshold for treatment and improves interpretation of tests results compared to text summary of sensitivity and specificity or Fagan's nomogram.

No MeSH data available.


Related in: MedlinePlus

CONSORT flowchart.
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pone.0128637.g002: CONSORT flowchart.

Mentions: We do not know precisely how many doctors viewed the banner advert, but we do know that 2,510 out of around 10,000 doctors opened the email from Dr Wendy Peek. The use of advertising banners is a standard in the website industry and can be used to reach the whole audience. Educational material on Doctors.net.uk is promoted by Dr Wendy Peek via a more targeted route of doctors who have previously expressed interest in educational materials and it was felt that this audience may be more receptive to participation in the study. In all, 917 doctors attempted the module between 10th July 2012 and 6th November 2012 and 874 doctors provided data on age, sex and professional status. Allocation to the four study arms is illustrated in Fig 2. There was a larger percentage of participants allocated to arm 1 (29.2%) compared to the average of the other three arms (23.4%).


Presentation of Diagnostic Information to Doctors May Change Their Interpretation and Clinical Management: A Web-Based Randomised Controlled Trial.

Ben-Shlomo Y, Collin SM, Quekett J, Sterne JA, Whiting P - PLoS ONE (2015)

CONSORT flowchart.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492926&req=5

pone.0128637.g002: CONSORT flowchart.
Mentions: We do not know precisely how many doctors viewed the banner advert, but we do know that 2,510 out of around 10,000 doctors opened the email from Dr Wendy Peek. The use of advertising banners is a standard in the website industry and can be used to reach the whole audience. Educational material on Doctors.net.uk is promoted by Dr Wendy Peek via a more targeted route of doctors who have previously expressed interest in educational materials and it was felt that this audience may be more receptive to participation in the study. In all, 917 doctors attempted the module between 10th July 2012 and 6th November 2012 and 874 doctors provided data on age, sex and professional status. Allocation to the four study arms is illustrated in Fig 2. There was a larger percentage of participants allocated to arm 1 (29.2%) compared to the average of the other three arms (23.4%).

Bottom Line: Younger age, postgraduate training and higher self-rated confidence all predicted better knowledge performance.Doctors with better knowledge were more likely to view an optional learning tutorial (OR per correct answer 1.18, 95% CI 1.06, 1.31).Presenting diagnostic data using a probability-modifying plot or natural frequency tree influences the threshold for treatment and improves interpretation of tests results compared to text summary of sensitivity and specificity or Fagan's nomogram.

View Article: PubMed Central - PubMed

Affiliation: School of Social & Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom.

ABSTRACT

Background: There is little evidence on how best to present diagnostic information to doctors and whether this makes any difference to clinical management. We undertook a randomised controlled trial to see if different data presentations altered clinicians' decision to further investigate or treat a patient with a fictitious disorder ("Green syndrome") and their ability to determine post-test probability.

Methods: We recruited doctors registered with the United Kingdom's largest online network for medical doctors between 10 July and 6" November 2012. Participants were randomised to one of four arms: (a) text summary of sensitivity and specificity, (b) Fagan's nomogram, (c) probability-modifying plot (PMP), (d) natural frequency tree (NFT). The main outcome measure was the decision whether to treat, not treat or undertake a brain biopsy on the hypothetical patient and the correct post-test probability. Secondary outcome measures included knowledge of diagnostic tests.

Results: 917 participants attempted the survey and complete data were available from 874 (95.3%). Doctors randomized to the PMP and NFT arms were more likely to treat the patient than those randomized to the text-only arm. (ORs 1.49, 95% CI 1.02, 2.16) and 1.43, 95% CI 0.98, 2.08 respectively). More patients randomized to the PMP (87/218-39.9%) and NFT (73/207-35.3%) arms than the nomogram (50/194-25.8%) or text only (30/255-11.8%) arms reported the correct post-test probability (p <0.001). Younger age, postgraduate training and higher self-rated confidence all predicted better knowledge performance. Doctors with better knowledge were more likely to view an optional learning tutorial (OR per correct answer 1.18, 95% CI 1.06, 1.31).

Conclusions: Presenting diagnostic data using a probability-modifying plot or natural frequency tree influences the threshold for treatment and improves interpretation of tests results compared to text summary of sensitivity and specificity or Fagan's nomogram.

No MeSH data available.


Related in: MedlinePlus