Action bias in the public’s clinically inappropriate expectations for antibiotics.

Abstract

Translational Abstract (150 -250 words)When people want antibiotics from their physician it encourages the physician to prescribe them, even if it is not clinically appropriate. Clinical guidelines recommend that physicians educate their patients about illnesses and antibiotics to eliminate any inappropriate desires for antibiotics. We tested whether providing clinical information to educate patients can completely eliminate inappropriate desires for antibiotics and whether a set of cognitive biases could explain why some people are not convinced by this information. We conducted four experiments with general adult participants from the United Kingdom. We found that adults who were told about the ineffectiveness and side effects of taking antibiotics for a viral infection were less likely to want antibiotics than those who did not receive this information.However, around 10% of people still wanted to take antibiotics even after being informed they are harmful and offer no benefit. Our findings suggest that this is driven by a strong desire 'to do something' to treat the infection, which can undermine educational efforts to inspire more judicial antibiotic health behaviours. Public Significance Statement (1 -3 sentences; approx. 30 to 70 words)This research finds that although people who are better informed about illnesses and antibiotics are less likely to choose to take antibiotics inappropriately, around 10% of people still want to take antibiotics even though they know they will be harmful and will offer no health benefits. This preference can be explained primarily by a desire to just do something. RUNNING HEAD: BIASES AND ANTIBIOTIC DECISIONS3 Abstract Clinical guidelines recommend that physicians educate patients about illnesses and antibiotics to eliminate inappropriate preferences for antibiotics. We expected that information provision about illnesses and antibiotics would reduce but not eliminate inappropriate preferences for antibiotics and that cognitive biases could explain why some people resist the effect of information provision. In two experiments, participants (n1 = 424; n2 = 434) either received incomplete information (about the viral aetiology of their infection) or complete information (about viral aetiology and the ineffectiveness and harms of taking antibiotics), before deciding to rest or take antibiotics. Those in the complete information conditions responded to items on four biases: action bias, social norm, source discrediting, and information neglect. In two follow-up experiments (n1 = 150; n2 = 732), we aimed to counteract the action bias by reframing the perception of the resting option as an action.Complete information provision reduced but did not eliminate inappropriate preferences for antibiotics. Around 10% of people wanted antibiotics even when informed they are harmful and offer no benefit and even when the alternative option (i.e., rest) was framed as an active treatment option. Results suggest an action bias underpins this preference but appears challenging to counteract.

Effect of information on reducing inappropriate expectations and requests for antibiotics

“…Our findings are aligned with existing research that educational interventions may reduce desires for antibiotics (Madle, Kostkova, Mani‐Saada, Weinberg, & Williams, 2004; Price et al, 2011; Roope et al, 2020; Thorpe et al, 2020a; Thorpe, Sirota, Juanchich, & Orbell, 2020b), but offer a distinct contribution by controlling for illness characteristics (severity and duration) and indicating that physicians might be empowered to change patient expectations during a consultation in which antibiotics are clinically inappropriate by providing information that specifically addresses ineffectiveness of antibiotics for the condition presented, and their side effects. Providing both illness and antibiotic information is recommended by NICE guidelines (PHE, 2017), and it is important to clarify that based on these findings we do not believe or recommend that physicians should not provide information on illness aetiology.…”

“…While some theoretical consideration has been applied to physician’s beliefs regarding antibiotic use (Donald, 2016), we believe this is the only study to have systematically examined the influence of prior knowledge alongside illness representations and treatment beliefs on the cognitive and motivational mechanisms underlying inappropriate expectations and requests for antibiotics. In the light of recent work assessing the effect of different combinations of messaging on inappropriate antibiotic expectations (Roope et al, 2020; Thorpe et al, 2020a, 2020b), the current research provides important causal evidence for the effect of specific types of clinical information provision on inappropriate antibiotic expectations and requests.…”

“…This could be because in our study it was a trusted medical professional who shared the information and not an institution. In the United Kingdom, family physicians are a trusted source of information and this trust may be a condition to the effect occurring (Thorpe et al, 2020b).…”

Context Matters: Emotional Sensitivity to Probabilities and the Bias for Action in Cancer Treatment Decisions

“…5,6 Ritov and Baron 5 first identified the omission bias for vaccine decisions, and many studies since have found that the bias toward inaction predominates for health decisions, 7 including vaccination, [8][9][10][11][12][13][14][15][16] medication, 14,17,18 and acute care decisions. 19,20 The less common tendency to err on the side of action is not unique to cancer and has been found for other health conditions, [20][21][22] but cancer does seem to particularly engage that tendency both for screening and for treatment. 4,[23][24][25] While ''do no harm'' may be a guiding principle for many health decisions, ''do whatever it takes,'' may be a prevailing perspective for cancer.…”

Explaining and reducing the public’s expectations of antibiotics: A utility-based signal detection theory approach.

“…For example, illness incoherence-being puzzled by the nature of an illness-predicted people's expectations of antibiotics for their recently experienced coldlike symptoms (Thorpe et al, 2021). Robust experimental evidence also showed that reducing laypeople's diagnostic uncertainty-by providing a family physician's clinical judgment about viral etiology of the symptoms, sometimes even accompanied by a diagnostic test pointing in the same direction-substantially decreased people's expectations of antibiotics in hypothetical consultations (Thorpe et al, 2020a(Thorpe et al, , 2020b(Thorpe et al, , 2021.…”