RESUMO
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.
RESUMO
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).
