Cited by 305COVID-19 Clinical Research StudiesClinical Reasoning and Diagnostic SkillsCOVID-19 and Mental Health

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

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Koffman, Jonathan, Gross, Jamie, Etkind, Simon Noah, Selman, Lucy·2020·Journal of the Royal Society of Medicine

DOI 10.1177/0141076820930665PMC PMC7439590

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Abstract

As if writing prophetically about the global Covid-19 pandemic, in 1984 Eddy suggested, “Uncertainty creeps into medical practice through every pore. Whether a physician is defining a disease, making a diagnosis, selecting a procedure, observing outcomes, assessing probabilities, assigning preferences, or putting it all together, he (or she) is walking on very slippery terrain” 1. Covid-19 has rapidly become a disease associated with unbridled uncertainty with its aetiology and management, for the healthcare systems and health professionals who provide care, and among its ultimate victims, patients and their families.

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Result
Comment on: “Advance” care planning reenvisioned
Bradshaw, A., Bayly, J., Penfold, C., Lin, C., Oluyase, A. O., Hocaoğlu, M., Murtagh, F. E., & Koffman, J. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17058 · Cited by 17
Self-citation
Qualitative exploration of nurses' experiences of the COVID ‐19 pandemic using the Reconceptualized Uncertainty in Illness Theory: An interpretive descriptive study
Turgut, Y., Öz, H. G., Akgün, M., Boz, İ., & Yangın, H. B. (2022) · Journal of Advanced Nursing · doi:10.1111/jan.15153 · Cited by 17
Conditional transparency: Differentiated news framings of COVID-19 severity in the pre-crisis stage in China
Xi, Y., Chen, A., & Ng, A. Y. K. (2021) · PLoS ONE · doi:10.1371/journal.pone.0252062 · Cited by 17
“An unregulated press also results in information inconsistency that confuses the public, negative reporting affecting the morale of crisis managers, and emotionally-charged interviews of victims that incite public discontent, all of which are obstacles to crisis handling [13, 59].”
Background
The COVID-19 pandemic and structural transformation in Africa: evidence for actionPreprint
Leininger, J., Strupat, C., Adeto, Y. A., Shimeles, A., & Wasike, W. S. K. (2021) · RePEc: Research Papers in Economics · doi:10.23661/dp11.2021 · Cited by 16
Social capital in Mexico moderates the relationship of uncertainty and cooperation during the SARS‐COV‐2 pandemic
Torres, C. E. C., & del Campo‐Ríos, J. M. (2021) · Journal of Community Psychology · doi:10.1002/jcop.22699 · Cited by 15
“…currently experiencing a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐ CoV‐2) (World Health Organization, 2021) that has rapidly become a disease with unpredictable impacts for health systems and society due to its etiology, spread, and management (Koffman et al., 2020).”
Background
Cognitive Abilities and Academic Achievement as Intercultural Competence Predictors in Russian School Students
Novikova, I., Gridunova, M. V., Novikov, A. L., & Shlyakhta, D. A. (2022) · Journal of Intelligence · doi:10.3390/jintelligence10020025 · Cited by 16
“The COVID-19 pandemic has forced almost every person to adapt to unknown conditions in a situation of high uncertainty and instability (Koffman et al. 2020; Kondratyuk et al. 2021; etc.).”
Background
Inpatient generalist palliative care during the SARS-CoV-2 pandemic – experiences, challenges and potential solutions from the perspective of health care workers
Schallenburger, M., Reuters, M. C., Schwartz, J., Fischer, M., Roch, C., Werner, L., Bausewein, C., Simon, S. T., van Oorschot, B., & Neukirchen, M. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-00958-9 · Cited by 14
Social Interpretation Inflexibility and Functioning: Associations with Symptoms and Stress
Deng, W., Everaert, J., Bronstein, M. V., Joormann, J., & Cannon, T. D. (2023) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2023.42.1.29 · Cited by 15
Leadership principles from Deuteronomy for the post-COVID-19 church
Coetsee, A. J. (2023) · doi:10.4102/aosis.2023.bk398.01 · Cited by 14
Semi-Automatic Systematic Literature Reviews and Information Extraction of COVID-19 Scientific Evidence: Description and Preliminary Results of the COKE Project
Golinelli, D., Nuzzolese, A. G., Sanmarchi, F., Bulla, L., Mongiovı̀, M., Aldo Gangemi, A., & Rucci, P. (2022) · Information · doi:10.3390/info13030117 · Cited by 15
“Although more than two years have elapsed, the human knowledge about the Coronavirus Disease 19 (COVID-19) is still pervaded by uncertainty [1,2].”
Background
Strengthening population medicine to promote public health
Wang, C., Chen, S., Shan, G., Leng, Z., Bärnighausen, T., & Yang, W. (2022) · Chinese Medical Journal · doi:10.1097/cm9.0000000000002221 · Cited by 14
The Fear of Surgery and Coronavirus in Patients Who Will Undergo a Surgical Intervention
Işıklı, A. G., Özkan, Z. K., & Buberka, Z. (2022) · Journal of PeriAnesthesia Nursing · doi:10.1016/j.jopan.2022.06.015 · Cited by 14
“Surgical interventions other than emergency surgeries have been postponed.(5) The surgery and the pandemic process have become a source of uncertainty and anxiety for patients, their relatives, and health care professionals.”
Background
Uncertainty as certainty in a COVID-19 complex world: Reflections on leading congregations for effective missional praxis
Magezi, C. (2023) · doi:10.4102/aosis.2023.bk398.08 · Cited by 13
Default or reset? Missional leadership challenges for church leaders in COVID-19 en route to the new normal
Marais, F., & Niemandt, N. (2023) · doi:10.4102/aosis.2023.bk398.09 · Cited by 13
Opportunities and challenges of AI-systems in political decision-making contexts
Tretter, M. (2025) · Frontiers in Political Science · doi:10.3389/fpos.2025.1504520 · Cited by 18
Altruists will be Altruists, but What About Individualists? The Role of Future Time Perspective and Social Value Orientation in Volunteers’ Declarations to Continue Engagement in Three Time Horizons
Nowakowska, I. (2023) · VOLUNTAS International Journal of Voluntary and Nonprofit Organizations · doi:10.1007/s11266-023-00613-8 · Cited by 12
“The social reality was also quite uncertain (regarding work circumstances, free time, and personal plans for the nearer and farther future, Koffman et al., 2020).”
Hope and bridgebuilding leadership in a post-COVID-19 context: Insights from 1 Peter
Leuven, E. T. F., & Kok, J. (2023) · doi:10.4102/aosis.2023.bk398.05 · Cited by 12
Leadership and the communication of ethics: Rawls and the COVID-19 pandemic
Kotzé, M. (2023) · doi:10.4102/aosis.2023.bk398.10 · Cited by 12
Re-imagining leadership in a post-COVID-19 glocal village to provide spiritual healing and pastoral care
Denton, R. A. (2023) · doi:10.4102/aosis.2023.bk398.06 · Cited by 12
Healing nostalgia among congregational leaders in post-COVID-19 Africa
Brunsdon, A. R. (2023) · doi:10.4102/aosis.2023.bk398.07 · Cited by 12
Bloated self-interest or humble Christian leadership: Reflections from Matthew 23:3–12
Viljoen, F. P. (2023) · doi:10.4102/aosis.2023.bk398.02 · Cited by 12
Paul as leader in the New Testament: How to avoid the ‘power paradox’
Cornelius, E. M. (2023) · doi:10.4102/aosis.2023.bk398.03 · Cited by 12
Christ-centred leadership in the Pauline Letters
Toit, P. L. G. D. (2023) · doi:10.4102/aosis.2023.bk398.04 · Cited by 12
Disability and self-care living strategies among adults living with HIV during the COVID-19 pandemic
O’Brien, K. K., Bayoumi, A. M., Carusone, S. C., Davis, A. M., Aubry, R. L., Avery, L. M., Solomon, P. E., Erlandson, K. M., Bergin, C. J., Harding, R., et al. (2021) · AIDS Research and Therapy · doi:10.1186/s12981-021-00413-4 · Cited by 12
“240 Table 2 – HIV Disability Questionnaire (HDQ) scores during the pandemic (n=63 participants) 241 HDQ Domain Presence Median (IQR) Severity Median (IQR) Episodic Median (IQR) Physical Symptoms 50 (25, 65) 16 (9, 25) 10 (0, 30) Cognitive Symptoms 66 (0, 100) 17 ( 0, 33) 0 (0, 33) Mental-Emotional Health Symptoms 73 (…”
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Failure of crisis leadership in a global pandemic: some reflections on COVID-19 and future recommendations
Okoli, J., Arroteia, N. F. P., & Ogunsade, A. I. (2022) · Leadership in health services · doi:10.1108/lhs-06-2022-0061 · Cited by 12
The Emotional Landscape of Pregnancy and Postpartum during the COVID-19 Pandemic in Italy: A Mixed-Method Analysis Using Artificial Intelligence
Ravaldi, C., Mosconi, L., Bonaiuti, R., & Vannacci, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12196140 · Cited by 11
“This aligns with the paper of Koffman et al. (2020), who noted that uncertainty became a constant presence in daily patients’ and HCPs’ lives [30].”
Background
Mothers’ Sources and Strategies for Managing COVID-19 Uncertainties during the Early Pandemic Months
Walker, K. K., Head, K. J., Bute, J. J., Owens, H. N., & Zimet, G. D. (2021) · Journal of Family Communication · doi:10.1080/15267431.2021.1928135 · Cited by 11
“Pandemics such as COVID-19 are representative of high uncertainty (Koffman et al., 2020).”
Background
Analysis of COVID-19 Guideline Quality and Change of Recommendations: A Systematic Review
Zhao, S., Lu, S., Wu, S., Wang, Z., Guo, Q., Shi, Q., Zhang, H., Zhang, J., Liu, H., Liu, Y., et al. (2021) · Health Data Science · doi:10.34133/2021/9806173 · Cited by 12
“To respond to the uncertainties around the disease, CPGs should be updated and strengthened as evidence evolves [3].”
Background
Using logistic regression to develop a diagnostic model for COVID-19: A single-center study
Nopour, R., Shanbehzadeh, M., & Kazemi-Arpanahi, H. (2022) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1017_21 · Cited by 11
“The exponential outbreak of the COVID‐19 and the continuously increased number of infected cases without effective treatment forces the medical fraternity to discover the many unfamiliar aspects of the disease.[23,24] In this situation, the health‐care industry is imposed with great pressure with severe shortages of i…”
Background
The COVID-19 Crises: The Threats, Uncertainties and Risks in Entrepreneurial Development
Abdelwahed, N. A. A., & Soomro, B. A. (2023) · Risks · doi:10.3390/risks11050089 · Cited by 11
Maladaptive changes in delay discounting in males during the COVID-19 pandemic: the predictive role of functional connectome
Xiao, Z., Chen, Z., Chen, W., Gao, W., He, L., Wang, Q., Lei, X., Qiu, J., Feng, T., Chen, H., et al. (2021) · Cerebral Cortex · doi:10.1093/cercor/bhab505 · Cited by 13
What Drives Belief in COVID-19 Conspiracy Theories? Examining the Role of Uncertainty, Negative Emotions, and Perceived Relevance and Threat
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“During the COVID-19 pandemic, people faced extremely high uncertainty due to a lack of understanding regarding the novel virus (Koffman et al., 2020).”
Background
Uncertainty in serious illness: A national interdisciplinary consensus exercise to identify clinical research priorities
Etkind, S. N., Barclay, S. I. G., Spathis, A., Hopkins, S., Bowers, B., & Koffman, J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0289522 · Cited by 10
Self-citation
In situ simulation improves perceived self-efficacy of OR nurses and anaesthesiologists during COVID-19 pandemic
Lois, F. J., Hallet, C. O., Suarez, N. S., Ghuysen, A., & Brichant, J. F. (2021) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2020-000840 · Cited by 10
Perceived Coping Mitigates Anxiety Symptoms in the Context of COVID-19 Stress in an Urban University Student Sample
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“The pandemic’s everchanging nature, and its associated uncertainty, has required populations to frequently adjust expectations and behaviors (Godinić et al., 2020; Koffman et al., 2020).”
Background
Relationship between intolerance of uncertainty and symptom severity in Covid-19 patients: the mediating role of illness perception and Covid-19 fear
Shahnawaz, M., Nabi, W., Nabi, S., Afaq, M., Paul, M. A., War, F. A., & Shah, N. N. (2022) · Current Psychology · doi:10.1007/s12144-022-03577-y · Cited by 14
“Despite the limitations, the results demonstrate a need to build the proper awareness about the disease among the public and, more importantly, among the patients and their families (Koffman et al., 2020).”
A comparative analysis of job satisfaction among military and airline pilots: During, and post COVID-19
Kioulepoglou, P., Chazapis, S., & Blundell, J. (2024) · Research in Transportation Business & Management · doi:10.1016/j.rtbm.2024.101103 · Cited by 10
Response to COVID‐19 in social welfare facilities and the psychological state of social workers in South Korea: The mediating role of satisfaction with government
Shin, S., & Gim, J. (2021) · Asian Social Work and Policy Review · doi:10.1111/aswp.12241 · Cited by 10
“Unlike viruses that have emerged in modern society, COVID- 19 is characterized by a very high likeliness to escalate and requires knowledge to successfully mitigate an epidemic (Koffman et al., 2020).”
Background
Scrolling TikTok to Soothe and Foster Self-Care During the COVID-19 Pandemic
Şot, I. (2023) · Social Media + Society · doi:10.1177/20563051231213542 · Cited by 11
“The pandemic has ushered in a period of uncertainty regarding its duration and how health care systems must deal with it (Koffman et al., 2020).”
Background
Social Media Users’ Engagement with Fear Appeal Elements in Government’s Health Crisis Communication via State-Owned Media
Yao, L., Ngai, C. S. B., Singh, R. G., & Chen, F. (2024) · Journal of Health Communication · doi:10.1080/10810730.2024.2378338 · Cited by 9
“This construct is particularly pertinent in emerging disease outbreaks with prevalent ambi-guities (Crowley et al., 2021; Freimuth, 2006; Koffman et al., 2020).”
Predicting Risk of Hospital Admission in Patients With Suspected COVID-19 in a Community Setting: Protocol for Development and Validation of a Multivariate Risk Prediction Tool
Espinosa-González, A. B., Neves, A. L., Fiorentino, F., Prociuk, D., Husain, L., Ramtale, S. C., Mi, E., Mi, E., Macartney, J., Anand, S. N., et al. (2021) · JMIR Research Protocols · doi:10.2196/29072 · Cited by 8
“The management of COVID-19 by clinicians is challenged by uncertainty about the disease progression [2].”
Background
Market‐focused flexibility and innovative performance in public healthcare: Evidence from India
Kumar, P. S. (2022) · Journal of Public Affairs · doi:10.1002/pa.2809 · Cited by 10
Differences in comprehending and acting on pandemic health risk information: a qualitative study using mental models
Berg, S. H., Shortt, M. T., Thune, H., Røislien, J., O'Hara, J. K., Lungu, D. A., & Wiig, S. (2022) · BMC Public Health · doi:10.1186/s12889-022-13853-y · Cited by 9
“This dynamic approach to sensemaking could be vital for pandemic health risks since the available evidence and the expert model continue to change [1].”
Background

Authors: Koffman, J., Gross, J., Etkind, S. N., & Selman, L.
Affiliations: King's College London (GB)
London North West Healthcare NHS Trust (GB)
University of Bristol (GB)
Corresponding author: Koffman, Jonathan
ORCID: Koffman, Jonathan
Gross, Jamie
Etkind, Simon Noah
Selman, Lucy
Venue: Journal of the Royal Society of Medicine
Publisher: SAGE Publications
Published: 2020-06
Volume: 113
Issue: 6
Pages: 211-216
ISSN: 0141-0768 (ISSN-L)
1758-1095
DOI: 10.1177/0141076820930665
PMC: PMC7439590
OpenAlex: W3025624029
Cited by: 305
References: 19
Citations by year: 2026: 11 · 2025: 22 · 2024: 57 · 2023: 76 · 2022: 67 · 2021: 67 · 2020: 5
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: Journal of the Royal Society of Medicine (publishedVersion, cc-by)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Bristol Research (University of Bristol) (submittedVersion, other-oa)
Apollo (University of Cambridge) (submittedVersion)
Apollo
Funders: National Institute for Health and Care Research (ACF-2012-17-020, CDF-2018-11-ST2-009)
Topics: Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords: COVID-19 pandemic, uncertainty, clinical decision-making, clinical uncertainty, pandemic response, diagnosis, treatment management
MeSH terms: Clinical Decision-Making, Betacoronavirus, COVID-19, SARS-CoV-2, Family, Health Personnel, Humans, Physician's Role, Pneumonia, Viral, Prognosis, Coronavirus Infections, Critical Pathways, Needs Assessment, Uncertainty, Emotional Intelligence, Pandemics

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

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