Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey

Background: The lack of evidence-based recommendations for therapeutic decisions during the early weeks of the COVID-19 pandemic creates a unique scenario of clinical decision making which is worth to analyze. We aim to identify the drivers of therapeutic aggressiveness during the first weeks of the...

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Autores:
Tipo de recurso:
Article of investigation
Fecha de publicación:
2020
Institución:
Universidad de Bogotá Jorge Tadeo Lozano
Repositorio:
Expeditio: repositorio UTadeo
Idioma:
eng
OAI Identifier:
oai:expeditiorepositorio.utadeo.edu.co:20.500.12010/14018
Acceso en línea:
https://doi.org/10.1016/j.eclinm.2020.100539
http://hdl.handle.net/20.500.12010/14018
Palabra clave:
COVID-19
Clinical decision-making
Surveys and questionnaires
Therapeutics
Uncertainty
Síndrome respiratorio agudo grave
COVID-19
SARS-CoV-2
Coronavirus
Rights
License
Abierto (Texto Completo)
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oai_identifier_str oai:expeditiorepositorio.utadeo.edu.co:20.500.12010/14018
network_acronym_str UTADEO2
network_name_str Expeditio: repositorio UTadeo
repository_id_str
dc.title.spa.fl_str_mv Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
title Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
spellingShingle Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
COVID-19
Clinical decision-making
Surveys and questionnaires
Therapeutics
Uncertainty
Síndrome respiratorio agudo grave
COVID-19
SARS-CoV-2
Coronavirus
title_short Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
title_full Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
title_fullStr Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
title_full_unstemmed Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
title_sort Understanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide survey
dc.subject.spa.fl_str_mv COVID-19
Clinical decision-making
Surveys and questionnaires
Therapeutics
Uncertainty
topic COVID-19
Clinical decision-making
Surveys and questionnaires
Therapeutics
Uncertainty
Síndrome respiratorio agudo grave
COVID-19
SARS-CoV-2
Coronavirus
dc.subject.lemb.spa.fl_str_mv Síndrome respiratorio agudo grave
COVID-19
SARS-CoV-2
Coronavirus
description Background: The lack of evidence-based recommendations for therapeutic decisions during the early weeks of the COVID-19 pandemic creates a unique scenario of clinical decision making which is worth to analyze. We aim to identify the drivers of therapeutic aggressiveness during the first weeks of the COVID-19 pandemic. Methods: This cross-sectional worldwide survey (conducted April 12 to 19, 2020) was aimed at physicians who managed patients diagnosed with COVID-19. Treatment preferences were collected in five different clinical scenarios. We used multilevel mixed-effects ordered logistic regression to identify variables that were associated with the use of more aggressive therapies. Findings: The survey was completed by 852 physicians from 44 different specialties and 29 countries. The heterogeneity of therapeutic decisions increased as the clinical scenario worsened. Factors associated with aggressive therapeutic decisions were higher self-perceived expertise (high vs. null, OR 1.95, 95%CI 1.31 2.89), perceived quality of COVID-19 publications (high vs. null, OR 1.92, 95%CI 1.17 3.16), and female sex (OR 1.17, 95%CI 1.02 1.33). Conversely, Infectious Diseases specialty, Latin American and North American origin, lower confidence in the treatments chosen, and having published articles indexed in PubMed as the first-author were associated with the use of less aggressive therapies. Interpretation: Our study provides insight into the drivers of the decision-making process during a new and extreme health emergency. Different factors including the perceived expertise and quality of publications, gender, geographic origin, medical specialty and implication in medica
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-09-30T15:19:48Z
dc.date.available.none.fl_str_mv 2020-09-30T15:19:48Z
dc.date.created.none.fl_str_mv 2020
dc.type.local.spa.fl_str_mv Artículo
dc.type.coar.spa.fl_str_mv http://purl.org/coar/resource_type/c_2df8fbb1
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dc.identifier.issn.spa.fl_str_mv 2589-5370
dc.identifier.other.spa.fl_str_mv https://doi.org/10.1016/j.eclinm.2020.100539
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12010/14018
dc.identifier.doi.spa.fl_str_mv https://doi.org/10.1016/j.eclinm.2020.100539
identifier_str_mv 2589-5370
url https://doi.org/10.1016/j.eclinm.2020.100539
http://hdl.handle.net/20.500.12010/14018
dc.language.iso.spa.fl_str_mv eng
language eng
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dc.rights.local.spa.fl_str_mv Abierto (Texto Completo)
rights_invalid_str_mv Abierto (Texto Completo)
http://purl.org/coar/access_right/c_abf2
dc.format.extent.spa.fl_str_mv 7 páginas
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.publisher.spa.fl_str_mv EClinicalMedicine
dc.source.spa.fl_str_mv reponame:Expeditio Repositorio Institucional UJTL
instname:Universidad de Bogotá Jorge Tadeo Lozano
instname_str Universidad de Bogotá Jorge Tadeo Lozano
institution Universidad de Bogotá Jorge Tadeo Lozano
reponame_str Expeditio Repositorio Institucional UJTL
collection Expeditio Repositorio Institucional UJTL
bitstream.url.fl_str_mv https://expeditiorepositorio.utadeo.edu.co/bitstream/20.500.12010/14018/2/license.txt
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spelling 2020-09-30T15:19:48Z2020-09-30T15:19:48Z20202589-5370https://doi.org/10.1016/j.eclinm.2020.100539http://hdl.handle.net/20.500.12010/14018https://doi.org/10.1016/j.eclinm.2020.100539Background: The lack of evidence-based recommendations for therapeutic decisions during the early weeks of the COVID-19 pandemic creates a unique scenario of clinical decision making which is worth to analyze. We aim to identify the drivers of therapeutic aggressiveness during the first weeks of the COVID-19 pandemic. Methods: This cross-sectional worldwide survey (conducted April 12 to 19, 2020) was aimed at physicians who managed patients diagnosed with COVID-19. Treatment preferences were collected in five different clinical scenarios. We used multilevel mixed-effects ordered logistic regression to identify variables that were associated with the use of more aggressive therapies. Findings: The survey was completed by 852 physicians from 44 different specialties and 29 countries. The heterogeneity of therapeutic decisions increased as the clinical scenario worsened. Factors associated with aggressive therapeutic decisions were higher self-perceived expertise (high vs. null, OR 1.95, 95%CI 1.31 2.89), perceived quality of COVID-19 publications (high vs. null, OR 1.92, 95%CI 1.17 3.16), and female sex (OR 1.17, 95%CI 1.02 1.33). Conversely, Infectious Diseases specialty, Latin American and North American origin, lower confidence in the treatments chosen, and having published articles indexed in PubMed as the first-author were associated with the use of less aggressive therapies. Interpretation: Our study provides insight into the drivers of the decision-making process during a new and extreme health emergency. Different factors including the perceived expertise and quality of publications, gender, geographic origin, medical specialty and implication in medica7 páginasapplication/pdfengEClinicalMedicinereponame:Expeditio Repositorio Institucional UJTLinstname:Universidad de Bogotá Jorge Tadeo LozanoCOVID-19Clinical decision-makingSurveys and questionnairesTherapeuticsUncertaintySíndrome respiratorio agudo graveCOVID-19SARS-CoV-2CoronavirusUnderstanding clinical decision-making during the COVID-19 pandemic: A cross-sectional worldwide surveyArtículohttp://purl.org/coar/resource_type/c_2df8fbb1Abierto (Texto Completo)http://purl.org/coar/access_right/c_abf2Martínez-Sanz, JavierPérez-Molina, Jose A.Moreno, SantiagoZamora, JavierSerrano-Villar, SergioLICENSElicense.txtlicense.txttext/plain; charset=utf-82938https://expeditiorepositorio.utadeo.edu.co/bitstream/20.500.12010/14018/2/license.txtabceeb1c943c50d3343516f9dbfc110fMD52open accessTHUMBNAILUnderstanding-clinical-decision-making-during-the-COVID-19-pa_2020_EClinical.pdf.jpgUnderstanding-clinical-decision-making-during-the-COVID-19-pa_2020_EClinical.pdf.jpgIM Thumbnailimage/jpeg16509https://expeditiorepositorio.utadeo.edu.co/bitstream/20.500.12010/14018/3/Understanding-clinical-decision-making-during-the-COVID-19-pa_2020_EClinical.pdf.jpg624bfb7e67eda38763d06053f872f89eMD53open access20.500.12010/14018oai:expeditiorepositorio.utadeo.edu.co:20.500.12010/140182021-03-17 20:01:09.34metadata only accessRepositorio Institucional - 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