How physicians interpret information about prescription drugs in scientific publications vs. promotional pieces

CDER researchers have conducted a randomized study to better understand how physicians make prescribing decisions.

As they make decisions about which drug products should be prescribed to their patients, physicians must process a great deal of relevant information in a limited amount of time. This information is from a wide range of sources, including but not limited to, FDA-approved labeling, peer-reviewed research published in scientific journals, continuing medical education, discussions with colleagues, and clinical practice guidelines. Physicians may also obtain information from drug advertising and promotion, including materials such as sales aids provided in person by sales representatives. CDER researchers recently conducted a randomized controlled study among primary care physicians to better understand how physicians process and interpret information that could guide prescribing decisions, and how such factors as time pressure, whether the information source is promotional in nature, and indicators of methodological rigor (e.g., sample size or duration) may influence physician’s perceptions of a drug product and prescribing.

The design of this study was based on concepts from the field of cognitive psychology and previous work that showed that when given a limited amount of time, people use heuristic or peripheral cues

(mental shortcuts) more than content in making decisions about a message. Over 600 doctors specializing in internal, family, or primary care medicine were asked to answer survey questions about a medical journal abstract describing the results of a clinical trial of a hypothetical diabetes. The physicians were randomly assigned to see the abstract presented in one of three ways: prominently labeled as a journal abstract, a sales aid without graphics, or sales aid with graphics. At two succeeding stages of randomization (Figure 1), physicians saw a version of the text that was either high or low in methodological rigor, and they had either unlimited time or only 30 seconds to view the text. Thus, this 3 x 2 x 2 design led to 12 different conditions to which the physicians could be assigned. Participants were asked a set of questions about their perceptions of the described study, the perceived benefits of the hypothetical drug, its riskiness, and whether they would prescribe it. CDER investigators statistically tested a set of relevant hypotheses about how information source (abstract, or promotion with or without graphics), methodologic rigor, and time pressure (Figure 2) influenced these outcome variables.

Among the main findings of the study were the following:

• Participants who viewed the abstract of the high-methodological rigor clinical study reported more perceived credibility and importance of the data, less need for interpreting the study data with caution, and less bias in the described study than those who viewed a low-rigor study (although there were not significant differences in perceptions of the benefits of using the hypothetical drug).

In discussing these findings, CDER researchers suggested that physicians consider methodological rigor when making decisions. Prominently disclosing information related to the methodological rigor of a study may help the audience form an accurate perception of the strength of the study and the support for claims in promotional communications. To better understand the impact of other advertising content, future research efforts could explore how physicians perceive studies that do not disclose detailed information about methodological rigor. The researchers also proposed that future examination of the role of evidence-based medicine training in physicians’ understanding of promotional materials.

• Study participants who were not under time pressure to read the text rated the fictitious study description as more credible, rigorous, and important, and had more confidence in study data than those who were under time pressure.

According to the authors, these results suggest that time pressure results in decisional caution, and that that future research could explore how selective attention, such as disinterest in a new drug to treat a specific disease, may influence time spent on an information piece. This finding may better explain how time pressure works in real-world scenarios. Additional research could also explore how time pressure when evaluating prescription drug promotional material increases the use of heuristic shortcuts, such as relying on brand names or study funding sources.

• No effects of source type (abstract, or promotion with or without graphics) were observed.

The authors of the study noted that when participants had unlimited time, they rated the information in the medical journal as more credible than they rated the sales aid, but when participants were pressed for time, they did not distinguish between the two. The investigators suggest that future work could also examine how different selection or framing of content may influence perceptions of source (e.g., promotional advertising or academic journal).

How does the source and quality of medical product information impact physician perceptions?

The results of this study suggest that prominently disclosing methodological rigor helps the audience form an accurate perception of the presented information. Further, additional findings showed that promotional communications without graphics that appear to be more closely related to study reprints or summaries may be approached and interpreted with less caution by physicians than promotional communications that fit the classic expectation of “promotion.” This highlights the importance that any promotional communications should be truthful and non-misleading.

Figure 2. study objectives, hypotheses and research questions addressed in the CDER research.

Reference

Aikin, Kathryn J., Amie C. O'Donoghue, Stephanie Miles, Maria DelGreco, and Panne Burke. "Physician interpretation of information about prescription drugs in scientific publications vs. promotional pieces." Research in Social and Administrative Pharmacy (2024).

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