Physicians' communication of Down syndrome screening test results: The influence of physician numeracy

Anderson, Britta L.; Obrecht, Natalie A.; Chapman, Gretchen B.; Driscoll, Deborah A.; Schulkin, Jay

doi:10.1097/gim.0b013e31821a370f

Cited by 32 publications

(32 citation statements)

References 14 publications

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“…Intention was not normally distributed and, as it could not be transformed successfully, we created 3 categories of intention—scores < 4, scores=4, and scores >4—based on the fact that the subtle gradations that span the 5-point scale made each category distinct in the clinical sense. In line with earlier research on health literacy, we dichotomized all health literacy variables: scores of 3HLQ were dichotomized as inadequate (≤10) or adequate (>10) [52]; scores of 3NQ were dichotomized as < 3 versus 3 correct answers [84]; and scores of SNS were dichotomized at the median (<3.75 vs≥3.75). Scores of S-TOFHLA could not be further analyzed because the lack of variability in the distribution did not enable us to discriminate among the pregnant women’s scores.…”

Section: Methodsmentioning

confidence: 99%

Role of Psychosocial Factors and Health Literacy in Pregnant Women’s Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

et al. 2016

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BackgroundDeciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs.ObjectiveThe objective of this study was to identify the influence of psychosocial factors on pregnant women’s intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women’s intention.MethodsWe conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses.ResultsOf the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92).ConclusionsImplementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.

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Section: Methodsmentioning

confidence: 99%

Role of Psychosocial Factors and Health Literacy in Pregnant Women’s Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

et al. 2016

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“…Previous studies assessing physician numeracy have used scales that were developed for the general population such as the three‐question Schwartz numeracy scale (Schwartz, Wobshin, Black, & Welch, ) or the subjective numeracy scale (SNS; Fagerlin, Zikmund‐Fisher, Ubel, Jankovic, Derry, & Smith, ). When the Schwartz scale was administered, a large majority of physicians answer all three questions correctly (Anderson et al., ). The SNS requires that participants rate their ability to use numbers and their preferences for numerical information rather than solve problems.…”

Section: Review Of Literaturementioning

confidence: 99%

Statistical Literacy in Obstetricians and Gynecologists

Anderson

Gigerenzer

Parker

et al. 2014

Journal for Healthcare Quality

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The Obstetrician-Gynecologist Statistical Literacy Questionnaire (OGSLQ) was designed to examine physicians' understanding of various number tasks that are relevant to obstetrician-gynecologists (ob-gyns) practice. Forty-seven percent of the nationally representative, practicing ob-gyns responded. Physicians did poorly on the questions about numerical facts (e.g., number of women living with HIV/AIDS), better on questions about statistical concepts (e.g., incidence, prevalence), and best on questions about numerical relationships (e.g., convert frequency to percentage) with 0%, 7%, 36%, answering all correctly, respectively. Only 19% correctly estimated the number of U.S. women with cancer. Sixty-six percent were able to use sensitivity and specificity to choose a test option. Around 90% could translate between frequency and probability formats. Forty-nine percent of respondents were able to calculate the positive predictive value of a mammography screening test. Physicians lack some understanding of statistical literacy. It is important that we monitor physicians' statistical literacy and provide training to students and physicians.

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“…Additionally, our findings appear to be generalisable, since in subsets of the MINT where results were available for comparison, FTs' performance was similar to that of medical students and doctors in previous U.S. studies (Sheridan and Pignone 2002;Gigerenzer et al 2007;Anderson et al 2011). Although other researchers have shown that medical students and doctors are prone to error in drug-dose calculation (Rowe et al 1998;Simpson et al 2009;Harries and Botha 2013), and in interpreting medical statistics (Sheridan and Pignone 2002;Windish et al 2007;Gigerenzer et al 2007;Wegwarth et al 2012;Johnson et al 2014), we are not aware of any other study that has explored clinician numeracy in comparable to depth to ours.…”

Section: Discussionmentioning

confidence: 55%

“…We observed little correlation between previous achievements in math at high-school and MINT score (r = 0.185 for level of math instruction, and r = 0.284 for math grade); this result is consistent with the finding of Ben-Shlomo et al (2004) in relation to the performance of medical students in epidemiology and biostatistical tests. On subsets of the MINT where data were available for comparison purposes, FTs performed significantly better than non-medical populations (Schwartz et al 1997;Sheridan et al 2003;Sikorskii et al 2011), and at a similar level to U.S. medical students and doctors (Sheridan and Pignone 2002;Gigerenzer et al 2007;Anderson et al 2011) (Tables 5 and 6). Psychometric analysis of the MINT is shown in Table 7.…”

Section: Overall Outcomementioning

confidence: 98%

Clinician Numeracy: Use of the Medical Interpretation and Numeracy Test in Foundation Trainee Doctors

Taylor¹,

Byrne‐Davis²

2017

Numeracy

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Patient safety is a priority in healthcare today. Good clinician numeracy in doctors contributes to patient safety, since it is essential for accuracy in prescribing, and in data interpretation. Evidence, however, suggests that although doctors are assumed to be highly numerate, they often make errors in drug dose calculation and struggle to interpret medical statistics. Having developed a new assessment measure, the Medical Interpretation and Numeracy Test (MINT), we describe its use to evaluate clinician numeracy in 135 recently qualified doctors in the UK ("foundation trainees," i.e., in their first two years post-graduation). The maximum possible test score was 43; the range of scores was 14 -42 (33 -98% correct), with an interquartile range of 29 -38 (67 -88%). Mean score was 32.76 (76%), with a 95% confidence interval of 31.6 to 33.9. Drug dose calculation errors were common, and potentially hazardous. Two thirds of participants had difficulty with simple data interpretation tasks designed for patients. Almost a quarter could not select the better of two treatment options when data were presented as relative risk reduction, absolute risk reduction or number needed to treat. Our study suggests that a significant proportion of medical graduates have poor clinician numeracy. Such doctors may harm patients by making mistakes in drug dose calculation and through flawed medical decision making. While further research is needed to investigate clinician numeracy in doctors, we believe that there is sufficient evidence to incorporate clinician numeracy into undergraduate and postgraduate medical education programs as a matter of patient safety.

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Physicians' communication of Down syndrome screening test results: The influence of physician numeracy

Cited by 32 publications

References 14 publications

Role of Psychosocial Factors and Health Literacy in Pregnant Women’s Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

Role of Psychosocial Factors and Health Literacy in Pregnant Women’s Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

Statistical Literacy in Obstetricians and Gynecologists

Clinician Numeracy: Use of the Medical Interpretation and Numeracy Test in Foundation Trainee Doctors

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