Patient Safety and Quality Improvement

Abstract

Introduction: The unpredictable nature of the COVID-19 pandemic portends further uncertainty in patient decisionmaking. This study explores decisional conflict and patientspecific concerns for people undergoing otolaryngologic surgery during the pandemic. Method: This was a prospective, single-institution, crosssectional study of English-speaking adults undergoing otolaryngologic surgery, conducted from April 22 to August 31, 2020. Individuals who were non-English speaking, lacked autonomous medical decision-making capacity, underwent emergent surgery, or had a communitive disability were excluded. The primary outcome of decisional conflict was measured using the validated “SURE” screening questionnaire. Relationships between decisional conflict and patient demographics were assessed via bivariate analyses, multivariable logistic regression, and conjunctive consolidation. The secondary outcome of patient-specific concerns was obtained through open-ended interview and qualitatively assessed using thematic analysis with open coding. Results: There was a 41% response rate (182 of 444 patients). The median age was 60.5 years (range 18-88);92 patients (51%) were women. Decisional conflict was more prevalent in non-White compared with White participants (difference 18%;95% CI, 0.6%-37.0% and adjusted odds ratio 3.0;95% CI, 1.2-7.4). Combining information from multiple variables through conjunctive consolidation, the group with the highest rate of decisional conflict was non- White patients with no college education, receiving urgent surgery. “Intraoperative” and “postoperative concerns” were the most common patient-specific concerns. Among those patients reporting concerns about COVID-19, the majority had decisional conflict. Conclusion: This study highlighted factors associated with decisional conflict and emphasized the need for physicians to engage in shared-decision making with patients. The COVID- 19 pandemic contributed to decisional conflict. Consistent discussion of risks and benefits is essential. The role of race and decisional conflict needs further study.