• Open Access

Interpretation by Clinicians of Probability Expressions in Cytology Reports and Effect on Clinical Decision-Making

Authors


  • 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.

Corresponding author: Mary M. Christopher, Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA 95616; e-mail: mmchristopher@ucdavis.edu.

Abstract

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.

Animals: None.

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.

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