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...
- 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)
id |
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oai:expeditiorepositorio.utadeo.edu.co:20.500.12010/14018 |
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UTADEO2 |
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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 |
format |
http://purl.org/coar/resource_type/c_2df8fbb1 |
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 |
dc.rights.coar.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 |
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 https://expeditiorepositorio.utadeo.edu.co/bitstream/20.500.12010/14018/3/Understanding-clinical-decision-making-during-the-COVID-19-pa_2020_EClinical.pdf.jpg |
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MD5 MD5 |
repository.name.fl_str_mv |
Repositorio Institucional - Universidad Jorge Tadeo Lozano |
repository.mail.fl_str_mv |
expeditio@utadeo.edu.co |
_version_ |
1814213511860977664 |
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 - Universidad Jorge Tadeo Lozanoexpeditio@utadeo.edu.coQXV0b3Jpem8gYWwgU2lzdGVtYSBkZSBCaWJsaW90ZWNhcyBVbml2ZXJzaWRhZCBkZSBCb2dvdMOhIEpvcmdlIFRhZGVvIExvemFubyBwYXJhIHF1ZSBjb24gZmluZXMgYWNhZMOpbWljb3MsIHByZXNlcnZlLCBjb25zZXJ2ZSwgb3JnYW5pY2UsIGVkaXRlIHkgbW9kaWZpcXVlIHRlY25vbMOzZ2ljYW1lbnRlIGVsIGRvY3VtZW50byBhbnRlcmlvcm1lbnRlIGNhcmdhZG8gYWwgUmVwb3NpdG9yaW8gSW5zdGl0dWNpb25hbCBFeHBlZGl0aW8KCkV4Y2VwdHVhbmRvIHF1ZSBlbCBkb2N1bWVudG8gc2VhIGNvbmZpZGVuY2lhbCwgYXV0b3Jpem8gYSB1c3VhcmlvcyBpbnRlcm5vcyB5IGV4dGVybm9zIGRlIGxhIEluc3RpdHVjacOzbiBhIGNvbnN1bHRhciB5IHJlcHJvZHVjaXIgZWwgY29udGVuaWRvIGRlbCBkb2N1bWVudG8gcGFyYSBmaW5lcyBhY2Fkw6ltaWNvcyBudW5jYSBwYXJhIHVzb3MgY29tZXJjaWFsZXMsIGN1YW5kbyBtZWRpYW50ZSBsYSBjb3JyZXNwb25kaWVudGUgY2l0YSBiaWJsaW9ncsOhZmljYSBzZSBsZSBkZSBjcsOpZGl0byBhIGxhIG9icmEgeSBzdShzKSBhdXRvcihzKS4KCkV4Y2VwdHVhbmRvIHF1ZSBlbCBkb2N1bWVudG8gc2VhIGNvbmZpZGVuY2lhbCwgYXV0b3Jpem8gYXBsaWNhciBsYSBsaWNlbmNpYSBkZWwgZXN0w6FuZGFyIGludGVybmFjaW9uYWwgQ3JlYXRpdmUgQ29tbW9ucyAoQXR0cmlidXRpb24tTm9uQ29tbWVyY2lhbC1Ob0Rlcml2YXRpdmVzIDQuMCBJbnRlcm5hdGlvbmFsKSBxdWUgaW5kaWNhIHF1ZSBjdWFscXVpZXIgcGVyc29uYSBwdWVkZSB1c2FyIGxhIG9icmEgZGFuZG8gY3LDqWRpdG8gYWwgYXV0b3IsIHNpbiBwb2RlciBjb21lcmNpYXIgY29uIGxhIG9icmEgeSBzaW4gZ2VuZXJhciBvYnJhcyBkZXJpdmFkYXMuCgpFbCAobG9zKSBhdXRvcihlcykgY2VydGlmaWNhKG4pIHF1ZSBlbCBkb2N1bWVudG8gbm8gaW5mcmluZ2UgbmkgYXRlbnRhIGNvbnRyYSBkZXJlY2hvcyBpbmR1c3RyaWFsZXMsIHBhdHJpbW9uaWFsZXMsIGludGVsZWN0dWFsZXMsIG1vcmFsZXMgbyBjdWFscXVpZXIgb3RybyBkZSB0ZXJjZXJvcywgYXPDrSBtaXNtbyBkZWNsYXJhbiBxdWUgbGEgVW5pdmVyc2lkYWQgSm9yZ2UgVGFkZW8gTG96YW5vIHNlIGVuY3VlbnRyYSBsaWJyZSBkZSB0b2RhIHJlc3BvbnNhYmlsaWRhZCBjaXZpbCwgYWRtaW5pc3RyYXRpdmEgeS9vIHBlbmFsIHF1ZSBwdWVkYSBkZXJpdmFyc2UgZGUgbGEgcHVibGljYWNpw7NuIGRlbCB0cmFiYWpvIGRlIGdyYWRvIHkvbyB0ZXNpcyBlbiBjYWxpZGFkIGRlIGFjY2VzbyBhYmllcnRvIHBvciBjdWFscXVpZXIgbWVkaW8uCgpFbiBjdW1wbGltaWVudG8gY29uIGxvIGRpc3B1ZXN0byBlbiBsYSBMZXkgMTU4MSBkZSAyMDEyIHkgZXNwZWNpYWxtZW50ZSBlbiB2aXJ0dWQgZGUgbG8gZGlzcHVlc3RvIGVuIGVsIEFydMOtY3VsbyAxMCBkZWwgRGVjcmV0byAxMzc3IGRlIDIwMTMsIGF1dG9yaXpvIGEgbGEgVW5pdmVyc2lkYWQgSm9yZ2UgVGFkZW8gTG96YW5vIGEgcHJvY2VkZXIgY29uIGVsIHRyYXRhbWllbnRvIGRlIGxvcyBkYXRvcyBwZXJzb25hbGVzIHBhcmEgZmluZXMgYWNhZMOpbWljb3MsIGhpc3TDs3JpY29zLCBlc3RhZMOtc3RpY29zIHkgYWRtaW5pc3RyYXRpdm9zIGRlIGxhIEluc3RpdHVjacOzbi4gRGUgY29uZm9ybWlkYWQgY29uIGxvIGVzdGFibGVjaWRvIGVuIGVsIGFydMOtY3VsbyAzMCBkZSBsYSBMZXkgMjMgZGUgMTk4MiB5IGVsIGFydMOtY3VsbyAxMSBkZSBsYSBEZWNpc2nDs24gQW5kaW5hIDM1MSBkZSAxOTkzLCBhY2xhcmFtb3MgcXVlIOKAnExvcyBkZXJlY2hvcyBtb3JhbGVzIHNvYnJlIGVsIHRyYWJham8gc29uIHByb3BpZWRhZCBkZSBsb3MgYXV0b3Jlc+KAnSwgbG9zIGN1YWxlcyBzb24gaXJyZW51bmNpYWJsZXMsIGltcHJlc2NyaXB0aWJsZXMsIGluZW1iYXJnYWJsZXMgZSBpbmFsaWVuYWJsZXMuCgpDb24gZWwgcmVnaXN0cm8gZW4gbGEgcMOhZ2luYSwgYXV0b3Jpem8gZGUgbWFuZXJhIGV4cHJlc2EgYSBsYSBGVU5EQUNJw5NOIFVOSVZFUlNJREFEIERFIEJPR09Uw4EgSk9SR0UgVEFERU8gTE9aQU5PLCBlbCB0cmF0YW1pZW50byBkZSBtaXMgZGF0b3MgcGVyc29uYWxlcyBwYXJhIHByb2Nlc2FyIG8gY29uc2VydmFyLCBjb24gZmluZXMgZXN0YWTDrXN0aWNvcywgZGUgY29udHJvbCBvIHN1cGVydmlzacOzbiwgYXPDrSBjb21vIHBhcmEgZWwgZW52w61vIGRlIGluZm9ybWFjacOzbiB2w61hIGNvcnJlbyBlbGVjdHLDs25pY28sIGRlbnRybyBkZWwgbWFyY28gZXN0YWJsZWNpZG8gcG9yIGxhIExleSAxNTgxIGRlIDIwMTIgeSBzdXMgZGVjcmV0b3MgY29tcGxlbWVudGFyaW9zIHNvYnJlIFRyYXRhbWllbnRvIGRlIERhdG9zIFBlcnNvbmFsZXMuIEVuIGN1YWxxdWllciBjYXNvLCBlbnRpZW5kbyBxdWUgcG9kcsOpIGhhY2VyIHVzbyBkZWwgZGVyZWNobyBhIGNvbm9jZXIsIGFjdHVhbGl6YXIsIHJlY3RpZmljYXIgbyBzdXByaW1pciBsb3MgZGF0b3MgcGVyc29uYWxlcyBtZWRpYW50ZSBlbCBlbnbDrW8gZGUgdW5hIGNvbXVuaWNhY2nDs24gZXNjcml0YSBhbCBjb3JyZW8gZWxlY3Ryw7NuaWNvIHByb3RlY2Npb25kYXRvc0B1dGFkZW8uZWR1LmNvLgoKTGEgRlVOREFDScOTTiBVTklWRVJTSURBRCBERSBCT0dPVMOBIEpPUkdFIFRBREVPIExPWkFOTyBubyB1dGlsaXphcsOhIGxvcyBkYXRvcyBwZXJzb25hbGVzIHBhcmEgZmluZXMgZGlmZXJlbnRlcyBhIGxvcyBhbnVuY2lhZG9zIHkgZGFyw6EgdW4gdXNvIGFkZWN1YWRvIHkgcmVzcG9uc2FibGUgYSBzdXMgZGF0b3MgcGVyc29uYWxlcyBkZSBhY3VlcmRvIGNvbiBsYSBkaXJlY3RyaXogZGUgUHJvdGVjY2nDs24gZGUgRGF0b3MgUGVyc29uYWxlcyBxdWUgcG9kcsOhIGNvbnN1bHRhciBlbjogaHR0cDovL3d3dy51dGFkZW8uZWR1LmNvL2VzL2xpbmsvZGVzY3VicmUtbGEtdW5pdmVyc2lkYWQvMi9kb2N1bWVudG9zCg== |