The science of choosing the right decision threshold in high-stakes diagnostics

Abstract

Many diagnostic tasks require that a threshold be set to convert evidence that is a matter of degree into a positive or negative decision. Although techniques of decision analysis used in psychology help one select the particular threshold that is appropriate to a given situation and purpose, just the concept of adjusting the threshold to the situation is not appreciated in many important practical arenas. Testing for the human immunodeficiency virus (HIV) and for dangerous flaws in aircraft structures are used here as illustrations. This article briefly reviews the relevant techniques and develops those two examples with data. It suggests that use of the decision techniques could substantially benefit individuals and society and asks how that use might be facilitated.