Spicer Jennifer O, Roberts Rebecca M, Hicks Lauri A
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2020 Nov 9;7(12):ofaa544. doi: 10.1093/ofid/ofaa544. eCollection 2020 Dec.
Inappropriate antibiotic use is common. Understanding how patients view antibiotic risks and/or benefits could inform development of patient education materials and clinician communication strategies. We explored current knowledge, attitudes, and behaviors related to antibiotics among populations with high antibiotic use.
We conducted 12 focus groups with adult patients and parents across the United States by telephone in March 2017. Purposive sampling was used to identify participants with high antibiotic use. We transcribed the discussions verbatim and performed thematic analysis.
We identified 4 major themes. First, participants expressed uncertainty regarding which clinical syndromes required antibiotics, and emotion often influenced their desire for antibiotics. Second, they had a limited understanding of antibiotic risks. Antibiotic resistance was viewed as the primary risk but was seen as a "distant, future" issue, whereas immediate adverse events, such as side effects, were minimized; however, patients expressed concern when told about the risk of serious adverse events. Third, they prioritized antibiotic benefits over risks in their decision-making, both due to an inaccurate estimation of antibiotic risks and/or benefits and a tendency to prioritize instant gratification. Fourth, most participants were willing to defer to their clinicians' decisions about antibiotics, especially if their clinician provided symptomatic treatment and anticipatory guidance.
Patients have a limited understanding of antibiotic risks, potentially explaining why they are willing to try antibiotics even if it is unclear antibiotics will help. Educating patients on the potential antibiotic risks versus benefits, rather than just antibiotic resistance, may have a bigger impact on their decision-making.
抗生素使用不当的情况很常见。了解患者如何看待抗生素的风险和/或益处可为患者教育材料的开发和临床医生的沟通策略提供参考。我们探讨了抗生素使用量高的人群中与抗生素相关的现有知识、态度和行为。
2017年3月，我们通过电话在美国各地对成年患者和家长进行了12次焦点小组访谈。采用目的抽样法确定抗生素使用量高的参与者。我们逐字转录了讨论内容并进行了主题分析。
我们确定了4个主要主题。首先，参与者对于哪些临床综合征需要使用抗生素表示不确定，情绪常常影响他们对抗生素的需求。其次，他们对抗生素风险的了解有限。抗生素耐药性被视为主要风险，但被看作是一个“遥远的未来”问题，而诸如副作用等即时不良事件则被最小化；然而，当被告知严重不良事件的风险时，患者表示担忧。第三，在决策过程中，他们将抗生素的益处置于风险之上，这既是由于对抗生素风险和/或益处的估计不准确，也是由于倾向于优先考虑即时满足感。第四，大多数参与者愿意听从临床医生关于抗生素的决定，尤其是如果他们的临床医生提供了对症治疗和预期指导。
患者对抗生素风险的了解有限，这可能解释了为什么即使不清楚抗生素是否会有帮助，他们也愿意尝试使用抗生素。就抗生素潜在的风险与益处而非仅仅是抗生素耐药性对患者进行教育，可能会对他们的决策产生更大影响。
