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. 2022 Sep 29;10(10):1914.
doi: 10.3390/healthcare10101914.

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

Joerg Haier  1 , Johannes Beller  1   2 , Kristina Adorjan  3 , Stefan Bleich  4 , Moritz de Greck  5 , Frank Griesinger  6 , Markus Heppt  7   8 , René Hurlemann  9 , Soeren Torge Mees  10 , Alexandra Philipsen  11 , Gernot Rohde  12 , Georgia Schilling  13 , Karolin Trautmann  14 , Stephanie E Combs  15 , Siegfried Geyer  2 , Juergen Schaefers  1
Affiliations

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

Joerg Haier et al. Healthcare (Basel). .

Abstract

Background: The early COVID-19-pandemic was characterized by changes in decision making, decision-relevant value systems and the related perception of decisional uncertainties and conflicts resulting in decisional burden and stress. The vulnerability of clinical care professionals to these decisional dilemmas has not been characterized yet. Methods: A cross-sectional questionnaire study (540 patients, 322 physicians and 369 nurses in 11 institutions throughout Germany) was carried out. The inclusion criterion was active involvement in clinical treatment or decision making in oncology or psychiatry during the first year of COVID-19. The questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, and the perception of consequences for patients). Data analysis was performed using ANOVA, Pearson rank correlations, and the Chi²-test, and for inferential analysis, nominal logistic regression and tree classification were conducted. Results: Professionals reported changes in clinical management (27.5%) and a higher workload (29.2%), resulting in decisional uncertainty (19.2%) and decisional conflicts (22.7%), with significant differences between professional groups (p < 0.005), including anxiety, depression, loneliness and stress in professional subgroups (p < 0.001). Nominal regression analysis targeting “Decisional Uncertainty” provided a highly significant prediction model (LQ p < 0.001) containing eight variables, and the analysis for “Decisional Conflicts” included six items. The classification rates were 64.4% and 92.7%, respectively. Tree analysis confirmed three levels of determinants. Conclusions: Decisional uncertainty and conflicts during the COVID-19 pandemic were independent of the actual pandemic load. Vulnerable professional groups for the perception of a high number of decisional dilemmas were characterized by individual perception and the psychological framework. Coping and management strategies should target vulnerability, enable the handling of the individual perception of decisional dilemmas and ensure information availability and specific support for younger professionals.

Keywords: COVID-19; decision conflicts; moral distress; oncology; psychiatry; uncertainty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Required modifications in clinical management due to pandemic; (B) changes in workload due to pandemic situation; (C) histogram of uncertainty perception throughout all participating groups; (D) decisional uncertainty within the stakeholder groups (mean and 95% CI).
Figure 2
Figure 2
(A) Histogram of decisional conflicts within professional groups; (B) regional distribution of decisional uncertainty and conflicts in Germany (mean and 95% CI).
Figure 3
Figure 3
(A) Histograms of personal conditions for professionals. (B) Burden due to decisional conflicts in different professional groups.
Figure 4
Figure 4
Factors of vulnerability to decisional conflicts of healthcare professionals during the pandemic: (A) age (p < 0.001) and (B) professional experience (n.s.).
Figure 5
Figure 5
Tree classification for parameters influencing (A) “Decisional Uncertainty” and (B) “Decisional Conflicts”.
Figure 5
Figure 5
Tree classification for parameters influencing (A) “Decisional Uncertainty” and (B) “Decisional Conflicts”.
See this image and copyright information in PMC

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