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Sharing treatment decisions may curb antibiotic use for otitis media


Parents' responses to three clinical vignettes-all of which featured a 2-½-year-old who has symptoms of acute otitis media (AOM)-show that they are less likely to want to give their child an antibiotic if the physician shares the treatment decision than if he (she) takes a paternalistic approach and clearly recommends using an antibiotic.

Investigators presented one of three vignettes to each of 466 parents in the waiting room of two family practice offices. Each parent (most were women) was asked to imagine that she was the parent in the vignette and to indicate her overall satisfaction with the visit depicted and her likelihood of using an antibiotic to treat AOM in her child. In all three vignettes, the physician first diagnosed AOM and then told the parent about efforts to cut back on antibiotic use because of antibiotic resistance and described the various options for managing children with AOM. The physician in the first vignette then clearly recommended treatment with an antibiotic.

In the second clinical vignette, the doctor did not make a direct recommendation but provided a safety-net prescription. In the third clinical vignette, the physician recommended acetaminophen and gave the parent a prescription for antibiotics to be started if the child did not improve in two to three days.

Commentary So much for the argument that we give antibiotics because parents demand them and that educating them about the alterative is too time-consuming. After relatively brief explanations, parents who were included in medical decisions in this model were likely to skip the antibiotic treatment for OM. Parents were satisfied with the care, and the hypothetical physicians would have been satisfied with the outcome. Watch for other applications of this inclusive approach!

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