Healthcare providers' perspectives on factors influencing their critical care decision-making during the COVID-19 pandemic: An international pilot survey.

Abstract

Background: Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making. One analytical technique that can be helpful in uncertain situations is clinical judgment. Clinicians must deal with contradictory information, lack of time to make decisions, and long-term factors when emergencies occur.

Aim: To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019 (COVID-19) pandemic and the factors affecting clinical decision-making.

Methods: This pilot study, which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19. The survey focused on topics related to their professional roles and personal relationships. We examined five core areas influencing critical care decision-making: Patients' personal factors, family-related factors, informed consent, communication and media, and hospital administrative policies on clinical decision-making. The collected data were analyzed using the χ ² test for categorical variables.

Results: A total of 102 clinicians from 23 specialties and 17 countries responded to the survey. Age was a significant factor in treatment planning (n = 88) and ventilator access (n = 78). Sex had no bearing on how decisions were made. Most doctors reported maintaining patient confidentiality regarding privacy and informed consent. Approximately 50% of clinicians reported a moderate influence of clinical work, with many citing it as one of the most important factors affecting their health and relationships. Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries. Regarding personal experiences, some respondents noted that treatment plans and preferences changed from wave to wave, and that there was a rapid turnover of studies and evidence. Hospital and government policies also played a role in critical decision-making. Rather than assessing the appropriateness of treatment, some doctors observed that hospital policies regarding medications were driven by patient demand.

Conclusion: Factors other than medical considerations frequently affect management choices. The disparity in treatment choices, became more apparent during the pandemic. We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency. False information, large patient populations, and limited resources caused problems for clinicians. These factors impacted decision-making, which, in turn, affected patient care and healthcare staff well-being.