Differences in Stakeholders’ Perception of the Impact of COVID-19 on Clinical Care and Decision-Making

Abstract

Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.

The impact of COVID‐19 on Australian clinicians' decision making in line with the principles of Choosing Wisely

“…For example, it was difficult to keep all members of large, multidisciplinary teams up-to-date with aerosol-generating procedures in theatre. This is consistent with findings in other studies where it has been reported that constantly changing protocols created ambiguity in how care was expected to be delivered (Chemali et al, 2020), and studies which highlighted challenges associated with incorporating multiple, new items of information into making decisions (Haier et al, 2022a). It is recognized that specialized the COVID-19 knowledge and experience was evolving during the first wave of the pandemic (Chemali et al, 2020;Lavoie, Bourque, Côté, et al, 2022), and thus it is important that clinicians recognize that decisions could only be based on the information available at the time (Lavoie, Bourque, Côté, et al, 2022).…”

“…Clinician decisions are typically complex, dynamic, and considerate of patient outcomes (Schuttner et al, 2022 ). The Australian government declared a national emergency response to the COVID‐19 pandemic in March 2020 and this decision‐making complexity was exacerbated during the first wave of the COVID‐19 pandemic as rapidly emerging evidence and experience meant that pandemic modelling, policies, and clinical protocols were constantly evolving (Chemali et al, 2020 ; de Caestecker & von Wissmann, 2021 ; Haier et al, 2022a ). Clinicians were required to make decisions locally to balance patient care with their safety, determine which patients to treat based on resource availability, and accept less comprehensive care for some patient cohorts (Iserson, 2020 ; Lavoie et al, 2022 ).…”