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4030 Final Study Guide

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Louisiana State University
PSYC 4030

Psychology 4030Final Study GuideHelping Doctors and Patients Make Sense of Health StatisticsWhat is collective statistical illiteracy p 54 What are the 3 main points in this monographCollective statistical illiteracy is the widespread inability to understand the meaning of numbers The three main points 1 It is common to patients physicians and politicians 2 It is created by nontransparent framing of information that may be unintentional or intentional 3 It can have serious consequences for healthWhat is the difference between absolute and relative risk Which type of risk doe the media tend to report p 54top of p 55Relative risk 100 higher The media tends to report this because the numbers seem largermore dramaticAbsolute risk 1 in 7000What is the difference between conditional probabilities and natural frequencies Which is easier to understand WhyConditional probabilities includes the sensitivity and the falsepositive rate 1specificity Natural frequencies a transparent representation that can achieve the same in comparison to conditional probabilities Natural frequencies are easier to understand because they represent the way humans encoded information before mathematical probabilities were invented They are simple counts that are not normalized with respect to base rates In the article the 4 natural frequencies added up to the total number of 1000 womenDefine positive predictive valueThe probability that a person has a disease given a positive screening test the probability that a positive test actually means that a person has the diseaseWhat is the key difference between survival and mortality rates What is the lead time biasSurvival rates imagine a group of people who are diagnosed with cancer on the same day The proportion of these patients who are still alive after a given amount of years ie 5 To calculate you take the number of patients diagnosed with cancer still alive X years after diagnosis and divide is by the number of patients diagnosed with cancerMortality rates imagine a group of people not defined by a caner diagnosis The proportion of people in the group who are dead after 1 year is the mortality rate To calculate the annual mortality rate you take the number of people who died from cancer over 1 year and divide it by the number of people in the groupThe key difference between these statistics is the word diagnosed It appears in the formula for the survival rate but not the mortality rateLead time bias screening biases survival in how it affects the timing of diagnosis For example there is a group of cancer patients currently diagnosed at age 67 all of whom die at age 70 The 5year survival of the group would be 0 If the group was diagnosed with cancer by tests earlier ie at age 60 and still died at 70their 5year survival rate would be 100 Survival rates change dramatically but time of death remains the sameWhat is the overdiagnosis bias1Leads to high survival ratesit is the detection of pseudodisease ie detect what seems like cancer but will not progress Even though the survival rate has changed the number of people who die has not changedWhat are the 4 questions we should ask about all risks1 Risk of what understand the outcome 2 Time frame understand the time 3 How big absolute terms13 out of 1000 will die by age 50 4 Does it apply to me see if the risk info is based on studies on people like yougender or age or similar health problemsWhat are some of the potential harms of screening testsCosts inconvenience and false alarmsand in our view the most important harm of overdiagnosis Overdiagnosis leads to hard through overtreatmentDistinguish between false positive and false negative errors in screening tests What is specificity and sensitivityFalse positive false alarm The test is positive in people who do not have the diseaseFalse negative miss The test is negative in someone who does have the diseaseSpecificity the proportion of negative tests among clients without the conditionSensitivity the proportion of positive tests among clients with the conditionWhat seems to be a necessary precondition for minimal statistical literacy Define the illusion of certaintyBasic numeracy knowing how to concert 1 to 10 in 1000 concert 1 in 1000 to 01 and how many heads in 1000 coin flipsIllusion of certainty an emotional need for certainty when none exists This feeling can be attached to test results that are taken to be absolutely certain and to treatments that appear to guarantee a cure According to Kalet Roberts and Fletcher 1994 how many patients discussed risks and benefits with their doctors during visits How does this relate to peoples ability to understand basic risksAudiotapes of 160 adult patents visits to doctors in North Carolina revealed that in only one out of four visits did the patient and doctor actually discuss risks or benefits Only few about one in six of these discussions were initiated by the patient and in the majority of the discussions the physician stated the risk with certainty Of the 42 patients who said that they actually had discussed risks with their doctors only 3 could recall immediately after the discussion what was said Yet almost all 90 felt that they had their questions answered had understood all that was said and had enough information This finding reveals that questionasking behavior was generally low and it suggests that many patients are reluctant to ask questions which is at odds with the goal of shared decision making According to research people are most likely to have a favorable evaluation of a treatment when benefits are described in what termsWhen the benefit of the test was presented in the form of relative risk reduction 80 of participants said they would likely accept the test ie if you have this test every 2 years it will reduce your chance of dying from this cancer by around 13 over the next 10 years Relative risk reduction would lead to more correct answers by patients 2
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