Design, validation and piloting of clinical vignettes to analyze critical care clinical decision processes during the COVID-19 pandemic in three different countries (Spain, Chile and United States)

Background: The use of heuristics in clinical decision-making processes increases in contexts of high uncertainty, such as those in Intensive Care Units (ICU. Given the impossibility of empirically studying their impact on real-world conditions, clinical vignettes were developed with the goal of identifying the use of heuristics in the care of critically ill patients during the COVID-19 pandemic in different clinical contexts.

Methodology: Vignettes were designed by critical care physicians in Spain to assess the use of representativeness, availability, and status quo heuristics in the care of critically ill patients during the COVID-19 pandemic. The construct, internal and external validity of the vignettes designed in Spain, the United States and Chile were evaluated. A questionnaire was piloted with the vignettes being validated in the three aforementioned countries through a computer application built for this purpose.

Results: 16 study vignettes grouped into 5 models were created: each model included between 2 and 4 vignettes. The vignettes designed were closed-response vignettes with 2-3 possible alternatives. The vignettes, initially developed in Spain in Spanish, were translated to English and adapted to the Spanish used in Chile. The clinical content of the vignettes was not modified during the translation process.

Conclusions: The vignettes allow for the study of the use of heuristics in critical care clinical decision making in the context of the COVID-19 pandemic. The piloting and validation process used can serve as a model for similar multinational studies exploring clinical decision making.