Reactions to uncertainty and the accuracy of diagnostic mammography.

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.