RAPID: Communicating difficult medical choices in a COVID-19 context

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Amidst the COVID-19 pandemic, healthcare providers face the challenge of how to make and communicate extremely difficult medical decisions. If medical decision-makers focus primarily on logic rather than emotion, they risk appearing callous, eroding public trust in the medical system and fostering negative reactions to medical advice. Yet, dire medical treatment situations might mandate a 'strict utilitarian' approach – one that focuses on saving the most lives by prioritizing care for patients with the best chance of survival. This may in turn produce a disconnect between the medical community and the public, since research shows that people tend to trust decision-makers who express emotional concern for individuals rather than the logic-based sacrificial judgment of saving lives overall. Thus, during the pandemic, healthcare providers overwhelmed by virus patients face an additional challenge: how to communicate about their medical decisions. If they focus mainly on their decision making without an emotional recognition of the situation, they may appear overly logical and not sufficiently emotional, thereby undermining trust in the medical community. When the public loses trust in the healthcare system, medical advice such as wearing masks or engaging in social distancing may be ignored. A better understanding of medical decision making and its communication can help shape future approaches to dealing with such dire situations in a way that maximizes the health-related outcomes for society. This project directly compares how healthcare providers versus laypeople view difficult and controvesial medical decision-making. The research tests the hypothesis that laypeople exonerate healthcare providers who communicate moral character by displaying a combination of emotional concern for individual targets (the patients who are very ill or dying) together with a logical focus on the big picture (reducing overall deaths). The research also tests the hypothesis that during the height of the crisis, people view the pandemic as similar to fighting a war, which makes medical sacrifices to treat the most patients seem more acceptable. As the crisis fades over time, however, people may no longer experience such a wartime mentality. If so, then some people may change their mind about healthcare providers’ medical decisions. To test these hypotheses, the research examines how the public views medical professionals’ sacrificial decisions near the height of the crisis and again one year later. Results will suggest communication strategies that healthcare providers can use to communicate moral concern when making difficult medical choices. The project includes development of a short video describing study results and recommending communication strategies.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.