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Prevalence and alternative explanations influence cancer diagnosis: an experimental study with physicians

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Title: Prevalence and alternative explanations influence cancer diagnosis: an experimental study with physicians
Authors: Sirota, M
Kostopoulou, O
Round, T
Samaranayaka, S
Item Type: Journal Article
Abstract: 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. (PsycINFO Database Record).
Issue Date: 1-May-2017
Date of Acceptance: 31-Oct-2016
URI: http://hdl.handle.net/10044/1/42309
DOI: https://dx.doi.org/10.1037/hea0000461
ISSN: 1930-7810
Publisher: American Psychological Association
Start Page: 477
End Page: 485
Journal / Book Title: Health Psychology
Volume: 36
Issue: 5
Copyright Statement: © 2017 American Psychological Association. This article may not exactly replicate the authoritative document published in the APA journal. It is not the copy of record.
Sponsor/Funder: Cancer Research UK
Funder's Grant Number: C33754/A12222
Keywords: Social Sciences
Psychology, Clinical
Psychology
cancer diagnosis
prevalence
alternative explanation
diagnostic reasoning
diagnostic support
SUGGESTIONS IMPROVE ACCURACY
RANDOMIZED CONTROLLED-TRIAL
WORKING-MEMORY CAPACITY
HYPOTHESIS GENERATION
PRIMARY-CARE
INFORMATION DISTORTION
INDIVIDUAL-DIFFERENCES
PROBABILITY JUDGMENT
LEADING HYPOTHESIS
SUSPECTED CANCER
Public Health
11 Medical And Health Sciences
13 Education
17 Psychology And Cognitive Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer