{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:18:29Z","timestamp":1777418309170,"version":"3.51.4"},"reference-count":26,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,10,19]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Point-of-care tests (POCTs) for infection offer accurate rapid diagnostics but do not consistently improve antibiotic stewardship (ASP) of suspected ventilator-associated pneumonia. We aimed to measure the effect of a negative PCR-POCT result on intensive care unit (ICU) clinicians\u2019 antibiotic decisions and the additional effects of patient trajectory and cognitive-behavioural factors (clinician intuition, dis\/interest in POCT, risk averseness).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cohort simulation study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>ICU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>70 ICU consultants\/trainees working in UK-based teaching hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinicians saw four case vignettes describing patients who had completed a course of antibiotics for respiratory infection. Vignettes comprised clinical and biological data (ie, white cell count, C reactive protein), varied to create four trajectories: clinico-biological improvement (the \u2018improvement\u2019 case), clinico-biological worsening (\u2018worsening\u2019), clinical improvement\/biological worsening (\u2018discordant clin better\u2019), clinical worsening\/biological improvement (\u2018discordant clin worse\u2019). Based on this, clinicians made an initial antibiotics decision (stop\/continue) and rated confidence (6-point Likert scale). A PCR-based POCT was then offered, which clinicians could accept or decline. All clinicians (including those who declined) were shown the result, which was negative. Clinicians updated their antibiotics decision and confidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Antibiotics decisions and confidence were compared pre-POCT versus post-POCT, per vignette.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A negative POCT result increased the proportion of stop decisions (54% pre-POCT vs 70% post-POCT, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      (1)=25.82, p&lt;0.001, w=0.32) in all vignettes except improvement (already high), most notably in discordant clin worse (49% pre-POCT vs 74% post-POCT). In a linear regression, factors that significantly reduced clinicians\u2019 inclination to stop antibiotics were a worsening trajectory (b=\u22120.73 (\u22121.33, \u20130.14), p=0.015), initial confidence in continuing (b=0.66 (0.56, 0.76), p&lt;0.001) and involuntary receipt of POCT results (clinicians who accepted the POCT were more inclined to stop than clinicians who declined it, b=1.30 (0.58, 2.02), p&lt;0.001). Clinician risk averseness was not found to influence antibiotic decisions (b=\u22120.01 (\u22120.12, 0.10), p=0.872).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A negative PCR-POCT result can encourage antibiotic cessation in ICU, notably in cases of clinical worsening (where the inclination might otherwise be to continue). This effect may be reduced by high clinician confidence to continue and\/or disinterest in POCT, perhaps due to low trust\/perceived utility. Such cognitive-behavioural and trajectorial factors warrant greater consideration in future ASP study design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073577","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T12:42:48Z","timestamp":1700570568000},"page":"e073577","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["WHY STOP? A prospective observational vignette-based study to determine the cognitive-behavioural effects of rapid diagnostic PCR-based point-of-care test results on antibiotic cessation in ICU infections"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-8966","authenticated-orcid":false,"given":"Suveer","family":"Singh","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Imperial College London, London, UK"},{"name":"Respiratory and Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4252-4692","authenticated-orcid":false,"given":"Martine","family":"Nurek","sequence":"additional","affiliation":[{"name":"Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Mason","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7095-7922","authenticated-orcid":false,"given":"Luke SP","family":"Moore","sequence":"additional","affiliation":[{"name":"Imperial College London, London, UK"},{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabeela","family":"Mughal","sequence":"additional","affiliation":[{"name":"Imperial College London, London, UK"},{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7894-873X","authenticated-orcid":false,"given":"Marcela P","family":"Vizcaychipi","sequence":"additional","affiliation":[{"name":"APMIC, Imperial College London, London, UK"},{"name":"Magill Department of Anaesthesia and Intensive Care Medicine, Chelsea and Westminster Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"2025121408311123000_13.11.e073577.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70318-9"},{"key":"2025121408311123000_13.11.e073577.2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0087"},{"key":"2025121408311123000_13.11.e073577.3","article-title":"Interventions to improve antibiotic prescribing practices for hospital Inpatients","volume":"2","author":"Davey","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121408311123000_13.11.e073577.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.2717"},{"key":"2025121408311123000_13.11.e073577.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1297"},{"key":"2025121408311123000_13.11.e073577.6","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s10096-015-2429-3","article-title":"A three-point time series study of antibiotic usage on an intensive care unit, following an antibiotic stewardship programme, after an outbreak of multi-resistant Acinetobacter Baumannii","volume":"34","author":"Singh","year":"2015","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025121408311123000_13.11.e073577.7","doi-asserted-by":"crossref","unstructured":"Sibony O , Kahneman D , HEC Paris, et al . Judgment. CL Playbook 2021. doi:10.53776\/playbooks-judgment","DOI":"10.53776\/playbooks-judgment"},{"key":"2025121408311123000_13.11.e073577.8","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-021-05618-6","article-title":"INHALE: the impact of using Filmarray pneumonia panel molecular diagnostics for hospital-acquired and ventilator-associated pneumonia on antimicrobial stewardship and patient outcomes in UK critical care\u2014study protocol for a Multicentre randomised controlled trial","volume":"22","author":"High","year":"2021","journal-title":"Trials"},{"key":"2025121408311123000_13.11.e073577.9","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.26691"},{"key":"2025121408311123000_13.11.e073577.10","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00476-17"},{"key":"2025121408311123000_13.11.e073577.11","doi-asserted-by":"crossref","unstructured":"Bachmann TT , L\u00fcdke G , Lisby JG , et al . Working group on antimicrobial resistance and rapid diagnostic testing. developmental roadmap for antimicrobial susceptibility testing systems. Nat Rev Microbiol 2019:51\u201362. doi:10.1038\/s41579-018-0098-9","DOI":"10.1038\/s41579-018-0098-9"},{"key":"2025121408311123000_13.11.e073577.12","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205766"},{"key":"2025121408311123000_13.11.e073577.13","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S2213-2600(19)30367-4","article-title":"Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (Vaprapid2): a randomised controlled trial and process evaluation","volume":"8","author":"Hellyer","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2025121408311123000_13.11.e073577.14","doi-asserted-by":"crossref","DOI":"10.21037\/atm-20-3701","article-title":"More research is required to understand factors influencing antibiotic prescribing in complex conditions like suspected ventilator-associated pneumonia","volume":"8","author":"Hellyer","year":"2020","journal-title":"Ann Transl Med"},{"key":"2025121408311123000_13.11.e073577.15","first-page":"134","article-title":"Attitudes to risk taking in medical decision making among British, Dutch and Belgian general practitioners","volume":"40","author":"Grol","year":"1990","journal-title":"Br J Gen Pract"},{"key":"2025121408311123000_13.11.e073577.16","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.6.3.e34","article-title":"Improving the quality of web surveys: the checklist for reporting results of Internet E-surveys (CHERRIES)","volume":"6","author":"Eysenbach","year":"2004","journal-title":"J Med Internet Res"},{"key":"2025121408311123000_13.11.e073577.17","doi-asserted-by":"crossref","unstructured":"Thaler R . What\u2019s next for nudging and choice architecture? Organ Behav Hum Decis Process 2020. doi:10.1016\/j.obhdp.2020.04.003","DOI":"10.1016\/j.obhdp.2020.04.003"},{"key":"2025121408311123000_13.11.e073577.18","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1111\/bioe.12421","article-title":"Manipulation, Salience, and Nudges","volume":"32","author":"Noggle","year":"2018","journal-title":"Bioethics"},{"key":"2025121408311123000_13.11.e073577.19","unstructured":"Walker HK . The origins of the history and physical examination. In: Walker HK , Hall WD , Hurst JW , eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths, 1990."},{"key":"2025121408311123000_13.11.e073577.20","unstructured":"Osler W . The Principles and Practice of Medicine. Appelton-Century Co, 1942."},{"key":"2025121408311123000_13.11.e073577.21","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X16644563"},{"key":"2025121408311123000_13.11.e073577.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012503","article-title":"Qualitative study of primary care Clinicians' views on point-of-care testing for C-reactive protein for acute respiratory tract infections in family medicine","volume":"7","author":"Hardy","year":"2017","journal-title":"BMJ Open"},{"key":"2025121408311123000_13.11.e073577.23","doi-asserted-by":"crossref","unstructured":"Pandolfo AM , Horne R , Jani Y , et al . Intensivists' beliefs about rapid Multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study. Antimicrob Resist Infect Control 2021;10. doi:10.1186\/s13756-021-00961-4","DOI":"10.1186\/s13756-021-00961-4"},{"key":"2025121408311123000_13.11.e073577.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0080633","article-title":"Understanding patients\u2019 adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the necessity-concerns framework","volume":"8","author":"Horne","year":"2013","journal-title":"PLoS One"},{"key":"2025121408311123000_13.11.e073577.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-012479"},{"key":"2025121408311123000_13.11.e073577.26","doi-asserted-by":"publisher","DOI":"10.1126\/science.2648573"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-073577","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:31:20Z","timestamp":1765729880000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-073577"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,21]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bmjopen-2023-073577"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-073577","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}