Educating physicians on strong opioids by descriptive versus simulated-experience formats: a randomized controlled trial

Abstract

Background Long-term prescriptions of strong opioids for chronic noncancer pain—which are not supported by scientific evidence—suggest miscalibrated risk perceptions among those who prescribe, dispense, and take opioids. Because risk perceptions and behaviors can differ depending on whether people learn about risks through description or experience, we investigated the effects of descriptive versus simulated-experience educative formats on physicians’ risk perceptions of strong opioids and their prescription behavior for managing chronic noncancer pain. Methods Three hundred general practitioners and 300 pain specialists in Germany—enrolled separately in two independent exploratory randomized controlled online trials—were randomly assigned to either a descriptive format (fact box) or a simulated-experience format (interactive simulation). Primary endpoints Objective risk perception (numerical estimates of opioids’ benefits and harms), actual prescriptions of seven therapy options for managing chronic pain. Secondary endpoint Implementation of intended prescriptions of seven therapy options for managing chronic pain. Results Both formats improved the proportion of correct numerical estimates of strong opioids’ benefits and harms immediately after intervention, with no notable differences between formats. Compared to description, simulated experience led to significantly lower reported actual prescription rates for strong and/or weak opioids, and was more effective at increasing prescription rates for non-drug-based therapies (e.g., means of opioid reduction) from baseline to follow-up for both general practitioners and pain specialists. Simulated experience also resulted in a higher implementation of intended behavior for some drug-based and non-drug-based therapies. Conclusions The two formats, which recruit different cognitive processes, may serve different risk-communication goals: If the goal is to improve exact risk perception, descriptive and simulated-experience formats are likely to be equally suitable. If, however, the goal is to boost less risky prescription habits, simulated experience may be the better choice. Trial registration DRKS00020358 (German Clinical Trials Register, first registration: 07/01/2020).

General practitioners’ risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study

“…Two further items initially intended to measure screening-related risk literacy were omitted due to lack of content proximity and low correlation with the treatment-related risk literacy score.To evaluate GPs’ conflicts of interest, participants answered five questions from a questionnaire by Lieb and colleagues14 that covered topics such as frequency of visits from pharmaceutical representatives, perceived influence of pharmaceutical representatives on prescribing behaviour and trustworthiness of received drug-related information. To investigate GPs’ perceptions of benefit–harm balance in low-value prescribing scenarios, participants were presented with three scenarios where evidence suggests an unfavourable benefit–harm ratio of prescribing: antibiotics for otitis media, long-term strong opioids for chronic noncancer pain)19 20 and benzodiazepines for insomnia. After each scenario, GPs were queried on their perception of the benefit–harm balance of prescribing using a 5-point scale (‘The benefits clearly outweigh the harms’, ‘The benefits somewhat outweigh the harms’, ‘Benefits and harms are balanced’, ‘The harms somewhat outweigh the benefits’, ‘The harms clearly outweigh the benefits’).…”

Vaccination Intention Following Receipt of Vaccine Information Through Interactive Simulation vs Text Among COVID-19 Vaccine–Hesitant Adults During the Omicron Wave in Germany

“…7 Given this potential to change minds, the key question is: how can vaccine-hesitant individuals' needs for balanced risk ratio information best be addressed? Evidence from cognitive and behavioral science suggests that interactive simulations of risk information, which imitate mechanisms by which humans sample risk information naturally (ie, sequentially and experientially), can be more effective in helping people to develop adequate risk perceptions and initiate behavioral change [8][9][10] than conventional text-based formats. 11,12 We therefore sought to determine the value of an interactive risk ratio simulation relative to a text-based format in prompting positive change in unvaccinated, vaccine-hesitant respondents' assessment of the COVID-19 vaccine's benefit-to-harm ratio and in their intention to get vaccinated during the Omicron wave in Germany.…”