Imperial College London
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DrOlgaKostopoulou

Faculty of Medicine, Department of Surgery & Cancer

Reader in Medical Decision Making
 
 
 
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Contact

 

o.kostopoulou Website

 
 
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Location

 

5.07Medical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kostopoulou:2019:10.1177/0272989X18813357,
author = {Kostopoulou, O and Nurek, M and Cantarella, S and Okoli, G and Fiorentino, F and Delaney, B and Kostopoulou, O and Nurek, M and Cantarella, S and Okoli, G and Fiorentino, F and Delaney, B},
doi = {10.1177/0272989X18813357},
journal = {Medical Decision Making},
pages = {21--31},
title = {Referral decision making of General Practitioners: a signal detection study},
url = {http://dx.doi.org/10.1177/0272989X18813357},
volume = {39},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background. Signal detection theory (SDT) describes how respondents categorize ambiguous stimuli over repeated trials. It measures separately “discrimination” (ability to recognize a signal amid noise) and “criterion” (inclination to respond “signal” v. “noise”). This is important because respondents may produce the same accuracy rate for different reasons. We employed SDT to measure the referral decision making of general practitioners (GPs) in cases of possible lung cancer. Methods. We constructed 44 vignettes of patients for whom lung cancer could be considered and estimated their 1-year risk. Under UK risk-based guidelines, half of the vignettes required urgent referral. We recruited 216 GPs from practices across England. Practices differed in the positive predictive value (PPV) of their urgent referrals (chance of referrals identifying cancer) and the sensitivity (chance of cancer patients being picked up via urgent referral from their practice). Participants saw the vignettes online and indicated whether they would refer each patient urgently or not. We calculated each GP’s discrimination (d ′) and criterion (c) and regressed these on practice PPV and sensitivity, as well as on GP experience and gender. Results. Criterion was associated with practice PPV: as PPV increased, GPs’c also increased, indicating lower inclination to refer (b = 0.06 [0.02–0.09]; P = 0.001). Female GPs were more inclined to refer than male GPs (b = −0.20 [−0.40 to −0.001]; P = 0.049). Average discrimination was modest (d′ = 0.77), highly variable (range, −0.28 to 1.91), and not associated with practice referral performance. Conclusions. High referral PPV at the organizational level indicates GPs’ inclination to avoid false positives, not better discrimination. Rather than bluntly mandating increases in practice PPV via more referrals, it is necessary to increase discrimina
AU  - Kostopoulou,O
AU  - Nurek,M
AU  - Cantarella,S
AU  - Okoli,G
AU  - Fiorentino,F
AU  - Delaney,B
AU  - Kostopoulou,O
AU  - Nurek,M
AU  - Cantarella,S
AU  - Okoli,G
AU  - Fiorentino,F
AU  - Delaney,B
DO  - 10.1177/0272989X18813357
EP  - 31
PY  - 2019///
SN  - 0272-989X
SP  - 21
TI  - Referral decision making of General Practitioners: a signal detection study
T2  - Medical Decision Making
UR  - http://dx.doi.org/10.1177/0272989X18813357
UR  - http://hdl.handle.net/10044/1/65761
VL  - 39
ER  -
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