Abstract: Providers’ Shared Decision-Making as a Predictor of Healthcare Outcomes in Managing Upper Respiratory Infections

◆ Michelle L. Acevedo Callejas, Penn State University
◆ Yanmengqian Zhou, Penn State University
◆ Erina L. MacGeorge, Penn State University
◆ Kasey Foley, Penn State University

Antibiotic resistance significantly threatens public health (Centers for Disease Control and Prevention [CDC], 2019). Injudicious prescribing for upper respiratory tract infections (URTIs; e.g., colds, coughs; Fleming-Dutra et al., 2016) contributes to the crisis. Much of this prescribing is due to patients’ expectations and demand for these drugs (Krockow et al., 2018), which in turn rest on misconceptions about the utility and risks of antibiotics (Hawking et al., 2016). Combating antibiotic resistance requires equipping providers with communication strategies to sustain patient satisfaction while upholding appropriate stewardship.
Shared decision-making (SDM) is an approach to patient care in which providers explain to patients the clinical factors involved in selecting a treatment plan, and treatments are jointly selected by patients and providers with attention to clinical factors and patients’ experiences (Chi, 2018; Elwyn et al., 2012; Elwyn et al., 2014). SDM has succeeded at improving patient trust and satisfaction in other contexts (see Rathert, Wyrwich, & Boren, 2013 for a review). Moreover, prior studies have shown that SDM interventions in visits for URTIs can reduce providers’ antibiotic prescribing (Legare & Labrecque, 2012). There is, however, insufficient evidence on how SDM affects other healthcare outcomes in this context that might contribute to patients’ subsequent antibiotic seeking, rationing, or other practices detrimental to antibiotic stewardship. We examined how SDM affected stewardship-relevant outcomes following medical visits for URTIs for patients who were not prescribed antibiotics.
Undergraduate students (N = 433) seeking care for an URTI were recruited from a student health center at a large eastern university. Participants completed surveys assessing study variables one and seven days after their appointments. Participants who received antibiotics were excluded from this analysis.
Patient perceptions of SDM predicted affective and cognitive outcomes at days 1 and 7 post-visit. On Day 1, SDM was positively associated with patients’ positive affect towards non-antibiotic treatment (b = .53, p < .001), perceived treatment quality (b = .24, p < .001), trust towards their provider (b = .62, p < .001), symptom management efficacy (b = .43, p < .01), and follow-up efficacy at (b = .51, p < .01). Also on Day 1, SDM was negatively associated with patients’ negative affect towards non-antibiotic treatment (b = -.46, p < .01). SDM also had an indirect effect on perceived treatment quality (b = .15, p < .001), trust towards their provider (b = .06, p < .01), and follow-up efficacy (b = .09, p < .01) through positive affect. Similarly, SDM also had an indirect effect on perceived treatment quality (b = .17, p < .001), trust towards their provider (b = .14, p < .001), and follow-up efficacy (b = .07, p < .01) through negative affect. On Day 7, through Day 1 cognitive responses, SDM predicted retrospective symptom management efficacy and retrospective follow-up efficacy.
These findings suggest that SDM can improve antibiotic stewardship by increasing patients’ trust in providers, confidence in the treatment plans they have been given, and perception that they can manage their illness without antibiotics.