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Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective

(1) Background: Uncertainty is typical for a pandemic or similar healthcare crisis. This affects patients with resulting decisional conflicts and disturbed shared decision making during their treatment occurring to a very different extent. Sociodemographic factors and the individual perception of pa...

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Autores principales: Haier, Jörg, Beller, Johannes, Adorjan, Kristina, Bleich, Stefan, De Greck, Moritz, Griesinger, Frank, Hein, Alexander, Hurlemann, René, Mees, Sören Torge, Philipsen, Alexandra, Rohde, Gernot, Schilling, Georgia, Trautmann, Karolin, Combs, Stephanie E., Geyer, Siegfried, Schäfers, Jürgen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222354/
https://www.ncbi.nlm.nih.gov/pubmed/35742070
http://dx.doi.org/10.3390/healthcare10061019
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author Haier, Jörg
Beller, Johannes
Adorjan, Kristina
Bleich, Stefan
De Greck, Moritz
Griesinger, Frank
Hein, Alexander
Hurlemann, René
Mees, Sören Torge
Philipsen, Alexandra
Rohde, Gernot
Schilling, Georgia
Trautmann, Karolin
Combs, Stephanie E.
Geyer, Siegfried
Schäfers, Jürgen
author_facet Haier, Jörg
Beller, Johannes
Adorjan, Kristina
Bleich, Stefan
De Greck, Moritz
Griesinger, Frank
Hein, Alexander
Hurlemann, René
Mees, Sören Torge
Philipsen, Alexandra
Rohde, Gernot
Schilling, Georgia
Trautmann, Karolin
Combs, Stephanie E.
Geyer, Siegfried
Schäfers, Jürgen
author_sort Haier, Jörg
collection PubMed
description (1) Background: Uncertainty is typical for a pandemic or similar healthcare crisis. This affects patients with resulting decisional conflicts and disturbed shared decision making during their treatment occurring to a very different extent. Sociodemographic factors and the individual perception of pandemic-related problems likely determine this decisional dilemma for patients and can characterize vulnerable groups with special susceptibility for decisional problems and related consequences. (2) Methods: Cross-sectional data from the OnCoVID questionnaire study were used involving 540 patients from 11 participating institutions covering all major regions in Germany. Participants were actively involved in clinical treatment in oncology or psychiatry during the COVID-19 pandemic. Questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, perception of consequences for patients) and very basic demographic data (age, gender, stage of treatment and educational background). Decision uncertainties and distress were operationalized using equidistant five-point scales. Data analysis was performed using descriptive and various multivariate approaches. (3) Results: A total of 11.5% of all patients described intensive uncertainty in their clinical decisions that was significantly correlated with anxiety, depression, loneliness and stress. Younger and female patients and those of higher educational status and treatment stage had the highest values for these stressors (p < 0.001). Only 15.3% of the patients (14.9% oncology, 16.2% psychiatry; p = 0.021) considered the additional risk of COVID-19 infections as very important for their disease-related decisions. Regression analysis identified determinants for patients at risk of a decisional dilemma, including information availability, educational level, age group and requirement of treatment decision making. (4) Conclusions: In patients, the COVID-19 pandemic induced specific decisional uncertainty and distress accompanied by intensified stress and psychological disturbances. Determinants of specific vulnerability were related to female sex, younger age, education level, disease stages and perception of pandemic-related treatment modifications, whereas availability of sufficient pandemic-related information prevented these problems. The most important decisional criteria for patients under these conditions were expected side effects/complications and treatment responses.
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spelling pubmed-92223542022-06-24 Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective Haier, Jörg Beller, Johannes Adorjan, Kristina Bleich, Stefan De Greck, Moritz Griesinger, Frank Hein, Alexander Hurlemann, René Mees, Sören Torge Philipsen, Alexandra Rohde, Gernot Schilling, Georgia Trautmann, Karolin Combs, Stephanie E. Geyer, Siegfried Schäfers, Jürgen Healthcare (Basel) Article (1) Background: Uncertainty is typical for a pandemic or similar healthcare crisis. This affects patients with resulting decisional conflicts and disturbed shared decision making during their treatment occurring to a very different extent. Sociodemographic factors and the individual perception of pandemic-related problems likely determine this decisional dilemma for patients and can characterize vulnerable groups with special susceptibility for decisional problems and related consequences. (2) Methods: Cross-sectional data from the OnCoVID questionnaire study were used involving 540 patients from 11 participating institutions covering all major regions in Germany. Participants were actively involved in clinical treatment in oncology or psychiatry during the COVID-19 pandemic. Questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, perception of consequences for patients) and very basic demographic data (age, gender, stage of treatment and educational background). Decision uncertainties and distress were operationalized using equidistant five-point scales. Data analysis was performed using descriptive and various multivariate approaches. (3) Results: A total of 11.5% of all patients described intensive uncertainty in their clinical decisions that was significantly correlated with anxiety, depression, loneliness and stress. Younger and female patients and those of higher educational status and treatment stage had the highest values for these stressors (p < 0.001). Only 15.3% of the patients (14.9% oncology, 16.2% psychiatry; p = 0.021) considered the additional risk of COVID-19 infections as very important for their disease-related decisions. Regression analysis identified determinants for patients at risk of a decisional dilemma, including information availability, educational level, age group and requirement of treatment decision making. (4) Conclusions: In patients, the COVID-19 pandemic induced specific decisional uncertainty and distress accompanied by intensified stress and psychological disturbances. Determinants of specific vulnerability were related to female sex, younger age, education level, disease stages and perception of pandemic-related treatment modifications, whereas availability of sufficient pandemic-related information prevented these problems. The most important decisional criteria for patients under these conditions were expected side effects/complications and treatment responses. MDPI 2022-05-31 /pmc/articles/PMC9222354/ /pubmed/35742070 http://dx.doi.org/10.3390/healthcare10061019 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Haier, Jörg
Beller, Johannes
Adorjan, Kristina
Bleich, Stefan
De Greck, Moritz
Griesinger, Frank
Hein, Alexander
Hurlemann, René
Mees, Sören Torge
Philipsen, Alexandra
Rohde, Gernot
Schilling, Georgia
Trautmann, Karolin
Combs, Stephanie E.
Geyer, Siegfried
Schäfers, Jürgen
Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective
title Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective
title_full Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective
title_fullStr Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective
title_full_unstemmed Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective
title_short Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective
title_sort decision conflicts in clinical care during covid-19: a patient perspective
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222354/
https://www.ncbi.nlm.nih.gov/pubmed/35742070
http://dx.doi.org/10.3390/healthcare10061019
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