Reactions to uncertainty and the accuracy of diagnostic mammography

Abstract

BACKGROUND: Reactions to uncertainty in clinical medicine can affect decision making. OBJECTIVE: To assess the extent to which radiologists' reactions to uncertainty influence diagnostic mammography interpretation. DESIGN: Cross-sectional responses to a mailed survey assessed reactions to uncertainty using a well-validated instrument. Responses were linked to radiologists' diagnostic mammography interpretive performance obtained from three regional mammography registries. PARTICIPANTS: One hundred thirty-two radiologists from New Hampshire, Colorado, and Washington. MEASUREMENT: Mean scores and either standard errors or confidence intervals were used to assess physicians' reactions to uncertainty. Multivariable logistic regression models were fit via generalized estimating equations to assess the impact of uncertainty on diagnostic mammography interpretive performance while adjusting for potential confounders. RESULTS: When examining radiologists' interpretation of additional diagnostic mammograms (those after screening mammograms that detected abnormalities), a 5-point increase in the reactions to uncertainty score was associated with a 17% higher odds of having a positive mammogram given cancer was diagnosed during follow-up (sensitivity), a 6% lower odds of a negative mammogram given no cancer (specificity), a 4% lower odds (not significant) of a cancer diagnosis given a positive mammogram (positive predictive value [PPV]), and a 5% higher odds of having a positive mammogram (abnormal interpretation). CONCLUSION: Mammograms interpreted by radiologists who have more discomfort with uncertainty have higher likelihood of being recalled. © 2007 Society of General Internal Medicine.