“Better” clinical decisions do not necessarily require more time to make

McCleary, Nicola; Francis, Jill J; Campbell, Marion K; Ramsay, Craig R; Eccles, Martin; Treweek, Shaun; Allan, Julia

doi:10.1016/j.jclinepi.2016.11.004

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…Other research has used patient scenarios to investigate primary care physicians' simulated antibiotic prescribing for upper respiratory tract infection. The study found that evidence-based (no prescribing) decisions were more likely when difficulty with decision-making was lower and decision time was shorter, indicating that appropriate prescribing decisions can be made quickly using a less effortful cognitive process (McCleary et al, 2017). These results consistently show that rapid clinical actions may involve the use of intuitive processes and can be as accurate as clinical actions involving reflective processes, supporting their appropriateness in clinical settings, which may be contrary to popular belief that careful reflection is always favoured.…”

Section: Presence Of Old Cuesmentioning

confidence: 94%

Implementation from a habit perspective

Potthoff¹,

McCleary²,

Sniehotta³

et al. 2020

Handbook on Implementation Science

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In their efforts to provide evidence-based care healthcare professionals prescribe, provide advice, conduct examinations, perform surgical procedures, and engage in a range of clinical behaviours. Their clinical actions are characteristically performed repeatedlysometimes multiple times per day -in the same physical locations with the same colleagues and patients, under constant time pressure and competing demands. This repetition under pressure in a stable setting provides ideal circumstances for creating contingencies between physical and social cues and clinical actions. Healthcare professional behaviour provides an ideal setting in which to advance theory, methods and interventions to better understand habit formation and habit reversal. Contemporary theoretical and methodological development in the psychology of habit has begun to be applied to understand and promote the formation, breaking, and replacement of habitual behaviour in healthcare professionals. This chapter highlights key theoretical approaches, methods, and intervention techniques that have been applied to conceptualize, measure, develop, and break habit and automaticity in healthcare professionals. These insights have the potential to synergistically contribute novel perspectives to the wider habit literature.

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Section: Presence Of Old Cuesmentioning

confidence: 94%

Implementation from a habit perspective

Potthoff¹,

McCleary²,

Sniehotta³

et al. 2020

Handbook on Implementation Science

Self Cite

View full text Add to dashboard Cite

show abstract

“…There were no differences in overall diagnostic accuracy between groups, but within both groups there was a negative correlation between accuracy and time, with cases diagnosed incorrectly taking significantly longer than cases diagnosed correctly. Further evidence using patient scenarios to investigate primary care physicians' simulated antibiotic prescribing for upper respiratory tract infection found that appropriate (no prescribing) decisions were more likely when difficulty with decision-making was lower and decision time was shorter, indicating that appropriate prescribing decisions can be made quickly using a less effortful cognitive process (McCleary et al, 2017). These results consistently show that rapid clinical actions may involve the use of intuitive processes and can be as accurate as clinical actions involving reflective processes, supporting their appropriateness in clinical settings, which may be contrary to popular belief that careful reflection is always favoured.…”

Section: Reflective Impulsive Model (Rim)mentioning

confidence: 99%

Creating and Breaking Habit in Healthcare Professional Behaviours to Improve Healthcare and Health

Potthoff

McCleary

Sniehotta

et al. 2018

The Psychology of Habit

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Healthcare professionals (HCPs) prescribe, provide advice, conduct examinations, perform surgical procedures, and engage in a range of clinical behaviours as part of their work in the service of providing care for patients and the public. Their actions are characteristically performed repeatedlysometimes multiple times, or multiple dozens of times per dayin the same physical locations with the same colleagues and patients, under constant time pressure and competing demands. This repetition under

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“…77 Inappropriate prescribing is related to clinical signs and symptoms, longer time in practice, 78 higher workload, time pressure, fear of complications, diagnostic uncertainty, and perceived 79 patient expectations 3,4 . Also, physicians may prescribe antibiotics when not clinically 80 indicated to maintain good relationships and avoid conflict 5 .…”

mentioning

confidence: 99%

“…Also, physicians may prescribe antibiotics when not clinically 80 indicated to maintain good relationships and avoid conflict 5 . Few studies have investigated 81 the influence of multiple factors simultaneously 3,4 , and it is not clear how these factors come 82 in to play at the moment of making a prescribing decision. Improving our understanding of 83 this could contribute to the design of more effective practice improvement interventions, 84 which often fail to address the specific factors influencing prescribing 6 .…”

mentioning

confidence: 99%

“…CB also highlighted implausible combinations of factor levels which were to be avoided (e.g., for sore throat, presence of purulent tonsils with absence of inflamed tonsils). The non-clinical factors and levels were selected based on the CB's recommendations, the guideline recommendations, and whether our previous work 4 or wider literature suggested the factor may influence decision-making. Table s2 presents the factors and levels selected, with justifications for inclusion.…”

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confidence: 99%

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Antibiotic prescribing for respiratory tract infection: exploring drivers of cognitive effort and factors associated with inappropriate prescribing

et al. 2021

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Background Antibiotics are over-prescribed for upper respiratory tract infection (URTI). It is unclear how factors known to influence prescribing decisions operate ‘in the moment’: dual process theories, which propose two systems of thought (‘automatic’ and ‘analytical’), may inform this. Objective(s) Investigate cognitive processes underlying antibiotic prescribing for URTI and the factors associated with inappropriate prescribing. Methods We conducted a mixed methods study. Primary care physicians in Scotland (n = 158) made prescribing decisions for patient scenarios describing sore throat or otitis media delivered online. Decision difficulty and decision time were recorded. Decisions were categorized as appropriate or inappropriate based on clinical guidelines. Regression analyses explored relationships between scenario and physician characteristics and decision difficulty, time and appropriateness. A subgroup (n = 5) verbalized their thoughts (think aloud) whilst making decisions for a subset of scenarios. Interviews were analysed inductively. Results Illness duration of 4+ days was associated with greater difficulty. Inappropriate prescribing was associated with clinical factors suggesting viral cause and with patient preference against antibiotics. In interviews, physicians made appropriate decisions quickly for easier cases, with little deliberation, reflecting automatic-type processes. For more difficult cases, physicians deliberated over information in some instances, but not in others, with inappropriate prescribing occurring in both instances. Some interpretations of illness duration and unilateral ear examination findings (for otitis media) were associated with inappropriate prescribing. Conclusion Both automatic and analytical processes may lead to inappropriate prescribing. Interventions to support appropriate prescribing may benefit from targeting interpretation of illness duration and otitis media ear exam findings and facilitating appropriate use of both modes of thinking.

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“Better” clinical decisions do not necessarily require more time to make

Abstract: This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link:

Cited by 4 publications

References 3 publications

Implementation from a habit perspective

Implementation from a habit perspective

Creating and Breaking Habit in Healthcare Professional Behaviours to Improve Healthcare and Health

Antibiotic prescribing for respiratory tract infection: exploring drivers of cognitive effort and factors associated with inappropriate prescribing

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