Social Judgement Theory and Medical Judgement

Wigton, Robert S.

doi:10.1080/135467896394492

Cited by 76 publications

(75 citation statements)

References 48 publications

(47 reference statements)

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“…A Judgement Analysis (JA) study based on social judgement theory 88 will be used at the end of Phase II to estimate the impact on GP behaviour of the trial results (availability of RADT information and/or clinical scores) in their assessment of patients. We will present the study results to both participating GPs and a further sample of 'naïve' GPs.…”

mentioning

confidence: 99%

PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study

Little

Hobbs

Moore

et al. 2014

Health Technol Assess

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Background Antibiotics are still prescribed to most patients attending primary care with acute sore throat, despite evidence that there is modest benefit overall from antibiotics. Targeting antibiotics using either clinical scoring methods or rapid antigen detection tests (RADTs) could help. However, there is debate about which groups of streptococci are important (particularly Lancefield groups C and G), and uncertainty about the variables that most clearly predict the presence of streptococci. Objective This study aimed to compare clinical scores or RADTs with delayed antibiotic prescribing. Design The study comprised a RADT in vitro study; two diagnostic cohorts to develop streptococcal scores (score 1; score 2); and, finally, an open pragmatic randomised controlled trial with nested qualitative and cost-effectiveness studies. Setting The setting was UK primary care general practices. Participants Participants were patients aged ≥ 3 years with acute sore throat. Interventions An internet program randomised patients to targeted antibiotic use according to (1) delayed antibiotics (control group), (2) clinical score or (3) RADT used according to clinical score. Main outcome measures The main outcome measures were self-reported antibiotic use and symptom duration and severity on seven-point Likert scales (primary outcome: mean sore throat/difficulty swallowing score in the first 2–4 days). Results The IMI TestPack Plus Strep A (Inverness Medical, Bedford, UK) was sensitive, specific and easy to use. Lancefield group A/C/G streptococci were found in 40% of cohort 2 and 34% of cohort 1. A five-point score predicting the presence of A/C/G streptococci [FeverPAIN: Fever; Purulence; Attend rapidly (≤ 3 days); severe Inflammation; and No cough or coryza] had moderate predictive value (bootstrapped estimates of area under receiver operating characteristic curve: 0.73 cohort 1, 0.71 cohort 2) and identified a substantial number of participants at low risk of streptococcal infection. In total, 38% of cohort 1 and 36% of cohort 2 scored ≤ 1 for FeverPAIN, associated with streptococcal percentages of 13% and 18%, respectively. In an adaptive trial design, the preliminary score (score 1; n = 1129) was replaced by FeverPAIN (n = 631). For score 1, there were no significant differences between groups. For FeverPAIN, symptom severity was documented in 80% of patients, and was lower in the clinical score group than in the delayed prescribing group (–0.33; 95% confidence interval –0.64 to –0.02; p = 0.039; equivalent to one in three rating sore throat a slight rather than moderately bad problem), and a similar reduction was observed for the RADT group (–0.30; –0.61 to 0.00; p = 0.053). Moderately bad or worse symptoms resolved significantly faster (30%) in the clinical score group (hazard ratio 1.30; 1.03 to 1.63) but not the RADT group (1.11; 0.88 to 1.40). In the delayed group, 75/164 (46%) used antibiotics, and 29% fewer used antibiotics in the clinical score group (risk ratio 0.71; 0.50 to 0.95; p = 0.018) and 27% fewer in the RADT group (0.73; 0.52 to 0.98; p = 0.033). No significant differences in complications or reconsultations were found. The clinical score group dominated both other groups for both the cost/quality-adjusted life-years and cost/change in symptom severity analyses, being both less costly and more effective, and cost-effectiveness acceptability curves indicated the clinical score to be the most likely to be cost-effective from an NHS perspective. Patients were positive about RADTs. Health professionals’ concerns about test validity, the time the test took and medicalising self-limiting illness lessened after using the tests. For both RADTs and clinical scores, there were tensions with established clinical experience. Conclusions Targeting antibiotics using a clinical score (FeverPAIN) efficiently improves symptoms and reduces antibiotic use. RADTs used in combination with FeverPAIN provide no clear advantages over FeverPAIN alone, and RADTs are unlikely to be incorporated into practice until health professionals’ concerns are met and they have experience of using them. Clinical scores also face barriers related to clinicians’ perceptions of their utility in the face of experience. This study has demonstrated the limitation of using one data set to develop a clinical score. FeverPAIN, derived from two data sets, appears to be valid and its use improves outcomes, but diagnostic studies to confirm the validity of FeverPAIN in other data sets and settings are needed. Experienced clinicians need to identify barriers to the use of clinical scoring methods. Implementation studies that address perceived barriers in the use of FeverPAIN are needed. Trial registration Current Controlled Trials ISRCTN32027234. Source of funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 6. See the NIHR Journals Library website for further project information.

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confidence: 99%

PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study

Little

Hobbs

Moore

et al. 2014

Health Technol Assess

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“…In fact they might even be using heuristics other than those investigated in this study, which might predict judgments and decisions better than the strategies investigated in the present study. This could be an interesting topic for future research but so far our data suggest that LR models could be as fast and frugal than the original F&F models [27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

“…It is common practice to use different regression models such as logistic regression (LR) to capture judgment policies and create normative models of human decision making behavior [1,2]. A recent review of how LR models could be applied for capturing medical decision making is given by Hamm and Young [3].…”

Section: Introductionmentioning

confidence: 99%

Statistical and Psychological Models of Doctors’ Judgments of Heart Patients

Kerimi¹,

Bäcklund²,

Skånér³

et al. 2017

J Clin Exp Cardiolog

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Using participant data from the medical domain, the robustness of logistic regression (LR) with different cue inclusion levels and two fast and frugal (F&F) models in terms of predictive accuracy and frugality were tested. Two data sets based on judgments of verbally described patients were used: Heart failure (66 analysts), and Hyperlipidemia (38 analysts). In both data sets, when the models were cross-validated, there was a significant decrease in predictive accuracy for all models, especially when all cues were used in LR. The other models had about equal predictive accuracy, also when comparisons were made with actual diagnoses, with a slight advantage for LR in the Heart failure study. LR using the 5% inclusion level was more frugal than F&F. These results emphasize the importance of using cross-validation and of choosing the proper significance levels for cue inclusion and when comparing different judgment models in medical decision making and other fields.

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“…Much psychological research has been directed at understanding decisionmaking, and many of these researchers have considered the clinical domain. One paradigm in the study of experts' decision making uses a mathematical technique known as judgement analysis to identify the relative weights assigned to different diagnostic cues (see Wigton for a review of this work applied to clinical decision making [13]). …”

Section: Studies Of Medical Decision-makingmentioning

confidence: 99%

A Review of Research Into the Development of Radiologic Expertise: Implications for Computer-Based Training

Taylor

2007

Academic Radiology

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Studies of radiological error reveal high levels of variation between radiologists.Although it is known that experts outperform novices, we have only limited knowledge about radiological expertise and how it is acquired. This review identifies three areas of research: studies of the impact of experience and related factors on the accuracy of decision-making; studies of the organisation of expert knowledge; and studies of radiologists' perceptual processes.Interpreting evidence from these three paradigms in the light of recent research into perceptual learning and studies of the visual pathway has a number of conclusions for the training of radiologists, particularly for the design of computer-based learning programs which are able to illustrate the similarities and differences between diagnoses, to give access to large numbers of cases and to help identify weaknesses in the way trainees build up a global representation from fixated regions.

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Social Judgement Theory and Medical Judgement

Cited by 76 publications

References 48 publications

PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study

PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study

Statistical and Psychological Models of Doctors’ Judgments of Heart Patients

A Review of Research Into the Development of Radiologic Expertise: Implications for Computer-Based Training

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