Healthy Skepticism Library item: 5762

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Publication type: Journal Article

Bramwell R, West H, Salmon P.
Health professionals' and service users' interpretation of screening test results: experimental study
BMJ 2006 Aug 5; 333:(7562):284
http://bmj.bmjjournals.com/cgi/content/short/333/7562/284?etoc%3e

Abstract:

Objective To investigate the accuracy of interpretation of probabilistic screening information by different stakeholder groups and whether presentation as frequencies improves accuracy.

Design Between participants experimental design; participants responded to screening information embedded in a scenario.

Setting Regional maternity service and national conferences and training days.

Participants 43 pregnant women attending their first antenatal appointment in a regional maternity service; 40 companions accompanying the women to their appointments; 42 midwives; 41 obstetricians. Participation rates were 56%, 48%, 89%, and 71% respectively.

Measures Participants estimated the probability that a positive screening test result meant that a baby actually had Down’s syndrome on the basis of all the relevant information, which was presented in a scenario. They were randomly assigned to scenarios that presented the information in percentage (n = 86) or frequency (n = 83) format. They also gave basic demographic information and rated their confidence in their estimate.

Results Most responses (86%) were incorrect. Obstetricians gave significantly more correct answers (although still only 43%) than either midwives (0%) or pregnant women (9%). Overall, the proportion of correct answers was higher for presentation as frequencies (24%) than for presentation as percentages (6%), but further analysis showed that this difference occurred only in responses from obstetricians. Many health professionals were confident in their incorrect responses.

Conclusions Most stakeholders in pregnancy screening draw incorrect inferences from probabilistic information, and health professionals need to be aware of the difficulties that both they and their patients have with such information. Moreover, they should be aware that different people make different mistakes and that ways of conveying information that help some people will not help others.