Van Scoy Lauren J, Duda Sarah H, Scott Allison M, Baker Arian, Costigan Heather, Loeffler Morgan, Sherman Michael S, Brown Michael D
Penn State University College of Medicine, Hershey, PA, United States.
University of Kentucky, Lexington, KY, United States.
Prev Med Rep. 2023 Feb;31:102104. doi: 10.1016/j.pmedr.2022.102104. Epub 2022 Dec 31.
The COVID-19 pandemic has led to contentious discourse regarding unproven COVID-19 therapies (UCTs),(e.g. ivermectin). Despite recommendations against it, ivermectin remains, in some areas, highly demanded. The goal of this study is to understand patient and provider perspectives about UCTs (e.g., ivermectin) and how responses to requests for UCTs impact healthcare distrust. This mixed methods observational study was conducted in a rural healthcare system in the Southern United States. Adults (n = 26) with a history of COVID-19 or clinicians (n = 8) from the same system were interviewed using questionnaires assessing healthcare distrust and qualitatively interviewed exploring perceptions about UCTs. Patient themes were: 1) Importance of anecdotal stories for decision-making; 2) Use of haphazard approaches to 'research'; 3) Strong distrust of government and healthcare organizations; 4) Inherent trust in local healthcare; 5) Decision-making as weighing pros/cons; and 6) Feeling a right to try medications. High survey medians indicated high distrust with differences of 8.5 points for those who requested/used ivermectin versus those who did not (p = 0.027). Clinician themes were: 1) Frustration when patients trust social media over clinicians; 2) Acceptance of community beliefs about UCTs; 3) Distrust originating outside of the healthcare system; 4) Feeling torn about prescribing UCTs to build trust; and 5) Variable educational strategies. When clinicians are perceived as aligned with government, this may void patients' trust of clinicians. Clinicians should leverage trust in local healthcare and distance themselves from distrusted information sources. Ethical questions arise regarding appropriateness of acquiescing to patient requests for ivermectin for building trust.
新冠疫情引发了关于未经证实的新冠治疗方法（UCTs）（如伊维菌素）的争议性讨论。尽管有反对建议，但在某些地区，伊维菌素的需求量仍然很高。本研究的目的是了解患者和医疗服务提供者对UCTs（如伊维菌素）的看法，以及对UCTs请求的回应如何影响医疗不信任。这项混合方法观察性研究在美国南部的一个农村医疗系统中进行。对有新冠病史的成年人（n = 26）或来自同一系统的临床医生（n = 8）进行了问卷调查，评估医疗不信任，并进行定性访谈，探讨对UCTs的看法。患者的主题有：1）轶事故事对决策的重要性；2）使用随意的“研究”方法；3）对政府和医疗组织的强烈不信任；4）对当地医疗的固有信任；5）权衡利弊的决策方式；6）感觉有权尝试药物。调查中位数较高表明不信任程度较高，请求/使用伊维菌素的人与未使用的人之间相差8.5分（p = 0.027）。临床医生的主题有：1）当患者信任社交媒体而非临床医生时感到沮丧；2）接受社区对UCTs的看法；3）源于医疗系统之外的不信任；4）对于为建立信任而开具UCTs感到左右为难；5）多样的教育策略。当临床医生被认为与政府一致时，这可能会消除患者对临床医生的信任。临床医生应利用对当地医疗的信任，并与不可信的信息来源保持距离。对于默许患者使用伊维菌素以建立信任的适当性，出现了伦理问题。
