Communicating diagnostic uncertainty reduces expectations of receiving antibiotics: Two online experiments with hypothetical patients.

The overprescription of antibiotics due to diagnostic uncertainty and inappropriate patient expectations influence antimicrobial resistance. This research assesses (i) whether communicating diagnostic uncertainty reduces expectations of receiving antibiotics and (ii) which communication strategies minimise unintended consequences of such communication. In two experimental online studies conducted in January and April 2023, participants read a vignette describing a doctor consultation for an ear infection and expressed their expectations of receiving antibiotics, trust in their doctor, rated the doctor's reputation and provided their intention to get a second doctor's opinion. Study 1 (N = 2213) investigated whether communicating diagnostic uncertainty and social externalities of antibiotic use (the negative social impacts of developing antibiotic resistance) decreases expectations for antibiotics and explores potential unintended consequences on the doctor-patient relationship. In Study 2 (N = 527), we aimed to replicate and extend the findings by adding specific treatment recommendations. Disclosing diagnostic uncertainty (vs. certainty) and communicating (vs. not communicating) the social externalities of antibiotic overuse reduced patients' expectations of receiving antibiotics. Yet, communicating uncertainty impaired trust in the doctor and the doctor's reputation. Combining the communication of uncertainty with specific treatment recommendations-particularly delayed antibiotic prescriptions-showed important to prevent these unintended consequences.

Understanding and reducing inappropriate antibiotic use in the context of delayed prescriptions.

OBJECTIVE: Antimicrobial resistance is a global health threat perpetuated by the overprescribing of antibiotics in primary care. One strategy to reduce antibiotic use in this setting is delayed prescribing. However, several psychological factors might undermine its effectiveness. The aim of the study was to test whether different interventions aiming at helping patients to manage diagnostic uncertainty in the period of watchful waiting promote appropriate antibiotic use. METHOD: We conducted a preregistered online experiment (N = 690 adult participants from the United Kingdom) in which we modeled delayed prescription in a decision task with behavior-contingent incentives. Participants had either a fictional viral or bacterial infection and received interventions that aimed at facilitating symptom monitoring (i.e., passive monitoring) and engaging participants in the task (i.e., active monitoring). RESULTS: Both interventions decreased antibiotic use when the disease was viral. Active monitoring was more efficient in decreasing antibiotic use than passive monitoring. CONCLUSIONS: The findings have practical implications for managing uncertainty and fostering appropriate antibiotic use in delayed prescribing situations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pupil dilation during memory encoding reflects time pressure rather than depth of processing.

Under cognitive load theory, time pressure/urgency-induced arousal is a major contributor to pupil dilation during cognition. However, pupillometric encoding studies have failed to consider the possible role of time pressure/urgency effects, instead often assuming that encoding dilations directly reflect encoding strength. To isolate possible encoding strength and time pressure effects, we manipulated levels of processing (deep vs. shallow) and response deadlines (speeded vs. unspeeded) during verbal recognition memory encoding. Rather than reflecting encoding strength, pupil dilation signaled time pressure and decision urgency, as indicated by four findings. First, dilation was greater for speeded than unspeeded trials, yet later recognition was similar. Second, within every combination of levels of processing and response deadline, slower individual decisions yielded increased dilations compared to quicker decisions. Third, even when encoding dilations during deep and shallow tasks were closely matched, later recognition remained markedly higher for the deep trials. Finally, within every combination of levels of processing and response deadline, dilation levels were similar for items subsequently recognized (hits) versus subsequently forgotten (misses). Taken together, our results support a time pressure/decision urgency account: instead of directly reflecting encoding efficacy, pupillary dilation mainly reflects the arousal induced by an increasingly urgent demand to process information. In the discussion section, we consider other possible paradigms during which arousal-based dilations may forecast subsequent memory outcomes, unlike here. Nonetheless, we emphasize that even in these situations, the proximal cause of dilation would be the time pressure or urgency of information processing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The willingness to vaccinate increases when vaccination protects others who have low responsibility for not being vaccinated.

Vaccination provides direct protection for the vaccinating individual and indirect protection for other, unvaccinated individuals via herd immunity. Still, some people do not get vaccinated-either because they cannot (e.g., due to health conditions) or they don't want to (e.g., due to vaccine hesitancy). We investigate whether non-vaccinators' level of responsibility for not being vaccinated affects individuals' motivation to vaccinate and, thus, to indirectly protect non-vaccinators. In Study 1 (N = 101), the intention to vaccinate increased (Cohen's d = 0.99) when non-vaccinators were described as willing but unable to get vaccinated (low responsibility) compared to when they were able but unwilling to get vaccinated (high responsibility). Study 2 (N = 297) replicated this finding with regard to vaccination behavior in an interactive vaccination (I-Vax) game (OR = 2.38). Additionally, knowing about non-vaccinators' low responsibility also increased the willingness to vaccinate compared to when there was no information on non-vaccinators' level of responsibility. Amplified levels of social welfare concerns in the case of non-vaccinators' low responsibility mediated the latter effect. This finding informs effective communication strategies for improving the vaccination rates.