Gist Representations and Decision-Making Processes Affecting Antibiotic Prescribing for Children with Acute Otitis Media

Objective. To test the predictions of fuzzy-trace theory regarding pediatric clinicians’ decision-making processes and risk perceptions about antibiotics for children with acute otitis media (AOM). Methods. We conducted an online survey experiment administered to a sample of 260 pediatric clinicians. We measured their risk perceptions and prescribing decisions across 3 hypothetical AOM treatment scenarios. Participants were asked to choose among the following options: prescribe antibiotics immediately, watchful waiting (“hedging”), or not prescribing antibiotics. Results. We identified 4 gists based on prior literature: 1) “why not take a risk?” 2) “antibiotics might not help but can hurt,” 3) “antibiotics do not have harmful side effects,” and 4) “antibiotics might have harmful side effects.” All 4 gists predicted risky choice (P < 0.001), and gist endorsements varied significantly between scenarios when antibiotics were indicated, F(2, 255) = 8.53, P < 0.001; F(2, 255) = 5.14, P < .01; and F(2, 255) = 3.56, P < 0.05 for the first 3 factors, respectively. In a logistic regression, more experienced clinicians were less likely to hedge (B = −0.05; P < 0.01). Conclusion. As predicted by fuzzy-trace theory, pediatric clinicians’ prescription decisions are associated with gist representations, which are distinct from verbatim risk estimates. Implications. Antibiotic stewardship programs can benefit by communicating the appropriate gists to clinicians who prescribe antibiotics for pediatric patients. HIGHLIGHTS: We found clinicians’ antibiotic prescription decisions were driven by gist representations of antibiotic risks for a given hypothetical patient scenario, and clinicians’ gist representations and verbatim risk estimates about antibiotic-related risks were distinct from each other. We showed that the effect of patient scenarios on clinicians’ antibiotic prescription decisions was mediated by clinicians’ gist representations. Less experienced clinicians tend to “hedge” in their antibiotic prescription decisions compared with more experienced clinicians. The broader impact of our study is that antibiotic stewardship programs can benefit by communicating the appropriate gists to clinicians who prescribe antibiotics for pediatric patients, rather than solely focusing on closing potential knowledge deficits of the clinicians.