Elsevier

The Lancet

Volume 351, Issue 9096, 10 January 1998, Pages 134-136
The Lancet

Essay
Personal significance: the third dimension

https://doi.org/10.1016/S0140-6736(97)06316-2Get rights and content

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Statistical significance

The mathematical model that underpins statistical thinking in clinical research applies probability—utility calculations of quantitative decision analysis. These models have an almost irresistible appeal in an era where “an answer is not considered to be a real answer unless it is numerical”.9 The crucial advantage that these mathematical models constantly seek is the reproducibility of the data produced by investigation. Scientists who are concerned about including qualitative factors into

Clinical significance

Although results may be statistically significant, the clinician is helped to interpret such evidence with the calculations that collectively constitute clinical significance. In general, there are four key calculations— absolute risk reduction, risk ratio, relative risk reduction (the complement of risk ratio expressed as a percentage), and the concept of numbers needed to treat (the inverse of the absolute risk reduction).12

These concepts, particularly the number needed to treat, have been of

Personal significance

Personal significance adds a further dimension and is the key to the transfer of an idea to, and in the evaluation and interpretation of the idea by, the doctor and the patient together. Personal significance is thus a dialectic, consisting of a contribution from the practitioner, who outlines the concept as the practitioner understands it, and the person who receives and evaluates the new idea.

The contribution of the doctor is threefold: evaluating the research evidence, exploring the

Challenge for the future

Recognising personal significance presents three challenges for health-care professionals. First, it requires the recognition of the influence of the doctor's personal characteristics in the transmission of a clinical message. Second, it challenges doctors to collaborate with the professions outside medicine who have already shown a serious interest in this area, analysing in particular the gap between intention to act and activity.21 These include disciplines such as behavioural psychology,

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