Abstract
Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants’ interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.
Highlights
Clinical decision-making is a complex cognitive process, based on the gathering of semeiotic and empirical evidence, which allows for the formulation of a diagnosis and the subsequent selection of specific treatments [1]
Researchers, along with policymakers, have tried to improve and standardise the clinical decision-making process by implementing a set of rules captured under the umbrella term of “evidence-based medicine” (EBM) [2]
Socio-demographic variables and responses to the COVID-19 questionnaire are shown in Tables 1 and 2
Summary
Clinical decision-making is a complex cognitive process, based on the gathering of semeiotic and empirical evidence, which allows for the formulation of a diagnosis and the subsequent selection of specific treatments [1]. Previous studies have shown that EBM represents only one of the components that guide medical decision-making, as this process is influenced by other, more personal factors, such as the clinicians’ attitudes and opinions [4], cognitive biases [5] and the information environment Enough, these individual influences profoundly affect medical practitioners, even in the presence of clear evidence-based recommendations. Sorum and colleagues [7] have demonstrated that regret can affect clinical decision-making in uncertain situations, so that physicians may be prompted to over-assess patients, even in the absence of symptoms and when evidence-based guidelines discourage such practices These authors observed that the likelihood of a physician ordering non-relevant medical exams for symptomless patients was associated with the regret they anticipated feeling if they had done nothing with an ill patient. Some studies have demonstrated the impact of stress and anxiety levels on decision-making in different categories of healthcare providers, such as surgeons [8, 9], dentists [10] and senior radiography students [11] (for a review, see [12])
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