# Heterogeneity in Responding to Clinical Vignettes Depicting Sepsis Suggests That Non-Medical Data May Drive the Decision-Making Process

## TL;DR

The study found that providers use different approaches to treat sepsis, and these differences may be influenced by non-medical factors like personal traits and work experience.

## Contribution

This study reveals that non-medical factors may influence sepsis treatment decisions, challenging the assumption of uniform clinical adherence.

## Key findings

- Providers showed varied treatment styles, including early, minimalist, and escalation approaches.
- Cluster #3, characterized by rapid treatment escalation, was associated with female, non-MD providers with ICU experience.
- Psychological variables were not the main drivers of treatment differences, but provider background and roles were.

## Abstract

Background/Objectives: Treating critically ill patients is complex and often subjective. This study investigates adherence to clinical guidelines for sepsis among different providers. Considering the strengths of the recommendations, we hypothesize that heterogeneity in the decision-making process will be low and independent of provider background and psychological makeup. Methods: This cohort study used two clinical vignettes of sepsis. Providers were given standardized treatment plans for 7 days, and their responses were recorded. Demographical, professional, and psychological (ambiguity tolerance, defensiveness, anxiety due to uncertainty, risk-taking behavior, decision styles, and optimism) variables were acquired. Results: Crystalloids were commonly used in both vignettes. Pressor engagement, especially norepinephrine, increased significantly after the third day. Providers recommended antibiotics and no provider stopped antibiotic therapy. Cluster analysis revealed no differences in therapy implementation among provider types, but some differences existed between the two vignettes. Cluster #1 was characterized by the implementation of early light bundle therapy combined with the use of pressors and a notable enhancement in therapies by the fifth day (Early Cluster). Cluster #2 (Minimalists) involved consistent engagement only in light bundle therapy throughout the treatment period. Cluster #3 (Escalation) comprised providers who rapidly escalated treatment using multiple different modalities. Cluster #3 stood out as most providers were female, non-MD, with significant ICU duties, and enhanced rational thinking. Conclusions: Providers differ in implementation styles of the sepsis treatment standard based on types of therapies selected not studied psychological variables.