The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.
Uncertainty and COVID-19: how are we to respond?
Open accessAbstract
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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“The protracted, inherently complex, and unpredictable nature of such adversities translates into numerous situational uncertainties about personal prospects and the possibility of achieving life goals [43,44].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [43]
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Cites
Wynants, L., Van Calster, B., Bonten, M. M., Collins, G. S., Debray, T. P., De Vos, M., Haller, M. C., Heinze, G., Moons, K. G., Riley, R. D., et al. (2020) · doi:10.1101/2020.03.24.20041020 · Cited by 3,070
Coping with Uncertainty: A Naturalistic Decision-Making Analysis
Lipshitz, R., & Strauss, O. (1997) · Organizational Behavior and Human Decision Processes · doi:10.1006/obhd.1997.2679 · Cited by 922
ICU-Acquired Weakness and Recovery from Critical Illness
Kress, J. P., & Hall, J. B. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1209390 · Cited by 902
Yang, Y., Yang, M., Shen, C., Wang, F., Yuan, J., Li, J., Zhang, M., Wang, Z., Xing, L., Wei, J., et al. (2020) · doi:10.1101/2020.02.11.20021493 · Cited by 836 · cited 1×
“positive for COVID-19 and those who have not, particularly if they present in emergency departments, a concern as the COVID-19 nasopharyngeal swab has a relatively high false-negative rate.(11) If patients are falsely screened-negative they may be sent to a ‘clean ward’ environment where they are potentially subjectin…”
BackgroundVariations in Physician Practice: The Role of Uncertainty
Eddy, D. M. (1984) · Health Affairs · doi:10.1377/hlthaff.3.2.74 · Cited by 573 · cited 1×
“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…”
BackgroundTolerating Uncertainty — The Next Medical Revolution?
Simpkin, A. L., & Schwartzstein, R. M. (2016) · New England Journal of Medicine · doi:10.1056/nejmp1606402 · Cited by 527 · cited 3×
“It also affects health professionals and it has been argued their tolerance of uncertainty can affect levels of investigation, patient safety, as well as healthcare resource use.(5) The authors of this commentary – an ITU physician, a palliative care physician and two social scientists – critically synthesise evidence…”
BackgroundInfluentialBernacki, R., Hutchings, M., Vick, J. B., Smith, G., Paladino, J., Lipsitz, S. R., Gawande, A. A., & Block, S. D. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-009032 · Cited by 468 · cited 1×
“Patients therefore may need assistance to recognise possible ‘trade-offs’ among their values and to understand the relationship between what is important to them and their families and treatment preferences.(22) If they are not able to obtain timely and accessible information and updates about loved ones, families mig…”
BackgroundDying with Dignity in the Intensive Care Unit
Cook, D., & Rocker, G. M. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1208795 · Cited by 331
Etkind, S. N., Bristowe, K., Bailey, K., Selman, L. E., & Murtagh, F. E. (2016) · Palliative Medicine · doi:10.1177/0269216316647610 · Cited by 150 · cited 1×
“Where uncertainty about their situation is present, patients become preoccupied to such an extent that their sense of self is changed.(19) Patients and their families often want to discuss their situation of uncertainty; however, this rarely happens.”
BackgroundSelf-citationPalliating a Pandemic: “All Patients Must Be Cared For”
Downar, J., & Seccareccia, D. (2010) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2009.11.241 · Cited by 122 · cited 1×
“including paramedics; liaison across provider networks to access knowledge for clinicians needing consultation support.(23)”
BackgroundCOVID-19 pandemic: triage for intensive-care treatment under resource scarcity
Swiss Academy of Medical Sciences (2020) · Swiss Medical Weekly · doi:10.4414/smw.2020.20229 · Cited by 113
Philippart, F., Vesin, A., Bruel, C., Kpodji, A., Durand-Gasselin, B., Garçon, P., Lévy-Soussan, M., Jagot, J.-L., Calvo-Verjat, N., Timsit, J., et al. (2013) · Intensive Care Medicine · doi:10.1007/s00134-013-2976-y · Cited by 102 · cited 1×
“This is despite evidence of older patients’ decreased willingness to want burdensome therapy or to risk severe disability to avoid death.(21) Patients therefore may need assistance to recognise possible ‘trade-offs’ among their values and to understand the relationship between what is important to them and their famil…”
BackgroundManaging Uncertainty — Harnessing the Power of Scenario Planning
Schwarze, M. L., & Taylor, L. J. (2017) · New England Journal of Medicine · doi:10.1056/nejmp1704149 · Cited by 76
Bristowe, K., Carey, I., Hopper, A., Shouls, S., Prentice, W. M., Caulkin, R., Higginson, I. J., & Koffman, J. (2015) · Palliative Medicine · doi:10.1177/0269216315578990 · Cited by 48 · cited 2×
“Evidence from an evaluation of a UK-developed intervention to serve patients whose situations were clinically uncertain and where there was a risk they may die during their hospital stay observed inconsistencies in information family members received with concomitant repercussions for satisfaction.(20) Additionally, f…”
BackgroundSelf-citationKoffman, J., Yorganci, E., Yi, D., Gao, W., Murtagh, F. E., Pickles, A. R., Barclay, S. I. G., Johnson, H., Wilson, R. J., Sampson, L., et al. (2019) · Trials · doi:10.1186/s13063-019-3612-0 · Cited by 32 · cited 1×
“health professionals to wear personal protective equipment and the possible absence of continuity of health professionals caring for them has potential to amplify this and more so if they are already confused as a direct consequence of their illness or from other co-morbidities.(16) Before the COVID-19 pandemic, evide…”
BackgroundSelf-citationNightingale, F. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511751349 · Cited by 30
Montgomery, J., Stokes-Lampard, H. J., Griffiths, M., Gardiner, D. D., Harvey, D., & Suntharalingam, G. (2020) · Journal of the Intensive Care Society · doi:10.1177/1751143720948537 · Cited by 27
Kirkegaard, P., Risør, M. B., Edwards, A., Junge, A. G., & Thomsen, J. L. (2012) · PubMed · Cited by 11
COVID-19: fail to prepare, prepare to fail
Abbasi, K. A. (2020) · Journal of the Royal Society of Medicine · doi:10.1177/0141076820918796 · Cited by 11
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Do we experience pandemic fatigue? current state, predictors, and prevention
Haktanır, A., Can, N., Seki, T., Kurnaz, M. F., & Dilmaç, B. (2021) · Current Psychology · doi:10.1007/s12144-021-02397-w · Cited by 161
Chen, H., Zhao, L., Cheng, L., Zhang, Y., Wang, H., Gu, K., Bao, J., Yang, J., Liu, Z., Huang, J., et al. (2022) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2022.100582 · Cited by 134
Kogan, L. R., Currin-McCulloch, J., Bussolari, C., Packman, W., & Erdman, P. (2021) · Animals · doi:10.3390/ani11072084 · Cited by 79
“Fears intensified as the number of cases grew exponentially and scientific knowledge of the means of transmission was limited and contradictory [2].”
Chutiyami, M., Bello, U. M., Salihu, D., Ndwiga, D. W., Kolo, M. A., Maharaj, R., Naidoo, K., Devar, L., Pratitha, P., & Kannan, P. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104211 · Cited by 73
Global Excess Mortality during COVID-19 Pandemic: A Systematic Review and Meta-Analysis
Shang, W., Wang, Y., Yuan, J., Guo, Z., Liu, J., & Liu, M. (2022) · Vaccines · doi:10.3390/vaccines10101702 · Cited by 73
“Comorbidities may complicate the assignment of COVID-19 and other illnesses on the death certificate [8,17,18].”
Metadata
- 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
- 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
- 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
- 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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