This work was presented in part, in abstract form, at the Association for Pathology Informatics Conference on Advancing Practice, Instruction, and Innovation through Informatics, Lake Tahoe, CA, August 24–26, 2005; and the American Society for Veterinary Clinical Pathology 41st Annual Meeting, Tucson, AZ, December 1–6, 2006.
Interpretation by Clinicians of Probability Expressions in Cytology Reports and Effect on Clinical Decision-Making
Article first published online: 22 MAR 2010
Copyright © 2010 by the American College of Veterinary Internal Medicine
Journal of Veterinary Internal Medicine
Volume 24, Issue 3, pages 496–503, May/June 2010
How to Cite
Christopher, M.M., Hotz, C.S., Shelly, S.M. and Pion, P.D. (2010), Interpretation by Clinicians of Probability Expressions in Cytology Reports and Effect on Clinical Decision-Making. Journal of Veterinary Internal Medicine, 24: 496–503. doi: 10.1111/j.1939-1676.2010.0492.x
- Issue published online: 7 MAY 2010
- Article first published online: 22 MAR 2010
- Submitted September 8, 2009; Revised February 9, 2010; Accepted February 9, 2010.
- Clinical pathology;
- Decision support;
- Evidence-based medicine;
- Oncology diagnosis;
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.
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.