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

在2019冠状病毒病大流行期间，医疗服务提供者面临着如何做出和传达极其困难的医疗决策的挑战。如果医疗决策者主要关注逻辑而不是情感，他们可能会显得冷酷无情，削弱公众对医疗系统的信任，并对医疗建议产生负面反应。然而，可怕的医疗情况可能需要一种“严格的功利主义”方法--一种通过优先照顾生存机会最好的病人来拯救最多生命的方法。这反过来可能会造成医学界和公众之间的脱节，因为研究表明，人们倾向于信任那些表达对个人情感关切的决策者，而不是基于逻辑的牺牲性判断来挽救生命。因此，在大流行期间，被病毒患者淹没的医疗服务提供者面临着额外的挑战：如何沟通他们的医疗决定。如果他们主要专注于自己的决策，而没有对情况的情感认识，他们可能会显得过于逻辑，而不是足够的情感，从而破坏对医学界的信任。当公众对医疗系统失去信任时，戴口罩或保持社交距离等医疗建议可能会被忽视。更好地了解医疗决策及其沟通可以帮助塑造未来的方法来处理这种可怕的情况，以最大限度地提高社会的健康相关成果。该项目直接比较了医疗保健提供者与外行人如何看待困难和有争议的医疗决策。这项研究测试了一个假设，即外行人通过对个体目标（重病或垂死的患者）的情感关注与对大局的逻辑关注（减少总体死亡）的结合来证明那些传达道德品质的医疗服务提供者无罪。这项研究还验证了一个假设，即在危机最严重的时候，人们认为大流行病类似于打一场战争，这使得医疗牺牲来治疗大多数病人似乎更容易接受。然而，随着危机逐渐消退，人们可能不再经历这种战时心态。如果是这样，那么有些人可能会改变他们对医疗保健提供者的医疗决定的看法。为了验证这些假设，研究调查了公众如何看待医疗专业人员在危机最严重时和一年后做出的牺牲决定。结果将建议沟通策略，医疗服务提供者可以用来沟通道德问题时，作出困难的医疗选择。该项目包括一个简短的视频描述研究结果和建议的沟通策略的发展。这个奖项反映了NSF的法定使命，并已被认为是值得通过使用基金会的智力价值和更广泛的影响审查标准进行评估的支持。

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.