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

Area of Science:

• Medical Psychology
• Health Services Research
• Oncology
• Psychiatry

Background:

• Healthcare crises like pandemics create uncertainty, leading to decisional conflicts and impaired shared decision-making for patients.
• Sociodemographic factors and individual perceptions of pandemic-related issues influence decisional dilemmas and identify vulnerable patient groups.
• Understanding these factors is crucial for managing patient distress and improving treatment outcomes during public health emergencies.

Purpose of the Study:

• To investigate decisional uncertainty and conflicts experienced by patients undergoing oncology or psychiatry treatment during the COVID-19 pandemic.
• To identify sociodemographic and treatment-related factors associated with patient vulnerability to decisional dilemmas.
• To explore the impact of information availability and risk perception on patient decision-making.

Main Methods:

• Cross-sectional data from 540 patients across 11 German institutions were collected via the OnCoVID questionnaire.
• Questionnaires assessed five decision dimensions: uncertainty, resources, risk perception, and consequences for clinical processes and patients.
• Data analysis involved descriptive statistics and multivariate approaches to identify determinants of decisional dilemmas.

Main Results:

• 11.5% of patients reported significant uncertainty, correlated with anxiety, depression, loneliness, and stress.
• Younger, female patients, and those with higher education and advanced treatment stages exhibited higher levels of distress.
• Only 15.3% considered COVID-19 infection risk important for decisions; key determinants for decisional dilemmas included information availability, education, age, and treatment decision needs.

Conclusions:

• The COVID-19 pandemic induced decisional uncertainty and psychological distress in patients, exacerbated by perceived treatment modifications.
• Vulnerability was linked to female sex, younger age, education level, and disease stage; adequate information provision was protective.
• Patients prioritized expected side effects, complications, and treatment response in their decision-making criteria.