Guidelines vs Mindlines: A qualitative investigation of how clinicians’ beliefs influence the application of rapid molecular diagnostics in intensive care

Stewart, Sarah-Jane, Pandolfo, Alyssa M., Jani, Yogini, Moon, Zoe, Brealey, David, Enne, Virve I., Livermore, David M. ORCID: https://orcid.org/0000-0002-9856-3703, Gant, Vanya, Brett, Stephen J. and Horne, Rob and INHALE WP4 Study Group (2024) Guidelines vs Mindlines: A qualitative investigation of how clinicians’ beliefs influence the application of rapid molecular diagnostics in intensive care. Antimicrobial Agents and Chemotherapy. ISSN 0066-4804 (In Press)

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Abstract

Rapid molecular diagnostic tests improve antibiotic stewardship (AMS) by facilitating earlier refinement of antimicrobial therapy. The INHALE trial tested the application of the BioFire FilmArray Pneumonia Panel (Pneumonia Panel) for antibiotic prescribing for hospital-acquired and ventilator-associated pneumonias (HAP/VAP) in UK intensive care units (ICUs). We report a behavioural study embedded within the INHALE trial examining clinicians’ perceptions of using these tests. Semi-structured interviews were conducted with 20 ICU clinicians after using the Pneumonia Panel to manage suspected HAP/VAP. Thematic analysis identified factors reinforcing perceptions of the necessity to modify antibiotic prescribing in accordance with test results, and doubts/concerns about doing so. While most acknowledged the importance of AMS, the test’s impact on prescribing decisions was limited. Concerns about potential consequences of under-treatment to the patient and prescriber were often more salient than AMS, sometimes leading to ‘just-in-case’ antibiotic prescriptions. Test results indicating a broad-spectrum antibiotic was unnecessary often failed to influence clinicians to avoid an initial prescription or de-escalate antibiotics early as they considered their use to be necessary to protect the patient and themselves, 'erring on the side of caution'. Some clinicians described cases where antibiotics would be prescribed for a sick patient regardless of test results because in their opinion, it fits with the clinical picture – “treating the patient, not the result”. Our findings illustrate a tension between prescribing guidelines and clinicians’ ‘mindlines’, characterised by previous experiences. This highlights the need for a 'technology plus' approach, recognizing the challenges clinicians face when applying technological solutions to patient care.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Depositing User:	LivePure Connector
Date Deposited:	16 Jan 2025 01:10
Last Modified:	16 Jan 2025 01:10
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98218
DOI:	issn:0066-4804

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