Uncertainty and COVID-19: how are we to respond?

Koffman, Jonathan; Gross, Jamie; Etkind, Simon Noah; Selman, Lucy E

doi:10.1177/0141076820930665

Cited by 238 publications

(189 citation statements)

References 17 publications

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“…Globally, health and social care systems are facing the unprecedented challenge of supporting those who are grieving, while continuing to treat those with severe disease and prevent the virus from spreading exponentially. It is a time of great uncertainty, 1,2 with the burden and course of future disease still unclear.…”

Section: Introductionmentioning

confidence: 99%

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

et al. 2020

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Background: The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events. Aim: To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond. Design: A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively ( www.crd.york.ac.uk/prospero , CRD 42020180723). Data sources: MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed. Results: Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. Conclusion: Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts.

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Section: Introductionmentioning

confidence: 99%

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

et al. 2020

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“…While emotive discussions, linked to expressing clinical uncertainty, have generally been seen as the job of designated health professionals, the recent COVID-19 global pandemic [ 60 ], has brought with it instances where more health professionals are required to do this work. Specifically, the COVID-19 pandemic has witnessed health professionals dealing with an extraordinary number of cases in acute hospital settings where clinical uncertainty is omnipresent across multiple levels including within the health-system, among professionals, and the patients and their families, for which the course of disease deterioration and potential for recovery is still relatively unknown [ 51 , 61 , 62 ]. As such, with considered modification, the AMBER care bundle has potential to offer health professionals with an approach to better serve patients affected by the COVID-19 and their families.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

et al. 2020

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Purpose To examine the use of Normalisation Process Theory (NPT) to establish if, and in what ways, the AMBER care bundle can be successfully normalised into acute hospital practice, and to identify necessary modifications to optimise its implementation. Method Multi-method process evaluation embedded within a mixed-method feasibility cluster randomised controlled trial in two district general hospitals in England. Data were collected using (i) focus groups with health professionals (HPs), (ii) semi-structured interviews with patients and/or carers, (iii) non-participant observations of multi-disciplinary team meetings and (iv) patient clinical note review. Thematic analysis and descriptive statistics, with interpretation guided by NPT components (coherence; cognitive participation; collective action; reflexive monitoring). Data triangulated across sources. Results Two focus groups (26 HPs), nine non-participant observations, 12 interviews (two patients, 10 relatives), 29 clinical note reviews were conducted. While coherence was evident, with HPs recognising the value of the AMBER care bundle, cognitive participation and collective action presented challenges. Specifically: (1) HPs were unable and unwilling to operationalise the concept of ‘risk of dying’ intervention eligibility criteria (2) integration relied on a ‘champion’ to drive participation and ensure sustainability; and (3) differing skills and confidence led to variable engagement with difficult conversations with patients and families about, for example, nearness to end of life. Opportunities for reflexive monitoring were not routinely embedded within the intervention. Reflections on the use of the AMBER care bundle from HPs and patients and families, including recommended modifications became evident through this NPT-driven analysis. Conclusion To be successfully normalised, new clinical practices, such as the AMBER care bundle, must be studied within the wider context in which they operate. NPT can be used to the aid identification of practical strategies to assist in normalisation of complex interventions where the focus of care is on clinical uncertainty in acute hospital settings.

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“…We hope that through this COVID-19 experience, pediatricians will lean more into the art of medicine by meeting patients' concerns with empathy, engaging with families to identify viable solutions, and expressing uncertainty together. 6 After all, "Medicine's ground state is uncertainty.…”

mentioning

confidence: 99%

Uncertainty in the COVID-19 Pandemic and the Art of Medicine

Vinci

2021

Pediatrics

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This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

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Uncertainty and COVID-19: how are we to respond?

Cited by 238 publications

References 17 publications

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

Uncertainty in the COVID-19 Pandemic and the Art of Medicine

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