A Precautionary Tale: Individual Decision Making in the Time of COVID-19

Precaution taking is an important part of managing COVID-19 and has been since the start of the pandemic. Guided by the Health Belief Model, two studies conducted during the beginning of the COVID-19 pandemic aimed to identify possible individual difference predictors of precautionary actions. Study 1 was an online, cross-sectional study using 763 adults aged 20–79 years old. Study 2, a 30-day daily diary study, examined daily precautions in 261 persons over the age of 55 years old. Study 1 and Study 2 indicated that COVID-19 knowledge predicted precautionary behaviors. Multilevel models from Study 2 indicated that daily increases in in-person interactions and leaving home were associated with decreases in precautions, but increases in disruption to routine were associated with increases in precautions. In both studies, including concurrent and lagged models in Study 2, significant interactions between information seeking and perceived risk suggested higher information seeking was related to higher precautions for those who consider themselves low risk. Findings highlight the burden of daily precautions and potentially modifiable factors of engagement in precautions.

A Precautionary Tale: Individual Decision Making in the Time of COVID-19.

Precaution taking is an important part of managing COVID-19 and has been since the start of the pandemic. Guided by the Health Belief Model, two studies conducted during the beginning of the COVID-19 pandemic aimed to identify possible individual difference predictors of precautionary actions. Study 1 was an online, cross-sectional study using 763 adults aged 20-79 years old. Study 2, a 30-day daily diary study, examined daily precautions in 261 persons over the age of 55 years old. Study 1 and Study 2 indicated that COVID-19 knowledge predicted precautionary behaviors. Multilevel models from Study 2 indicated that daily increases in in-person interactions and leaving home were associated with decreases in precautions, but increases in disruption to routine were associated with increases in precautions. In both studies, including concurrent and lagged models in Study 2, significant interactions between information seeking and perceived risk suggested higher information seeking was related to higher precautions for those who consider themselves low risk. Findings highlight the burden of daily precautions and potentially modifiable factors of engagement in precautions.

Pediatric Chemotherapy Infusions in Outpatient Examination Rooms: A Novel Patient Care Approach.

Background: Many health care organizations offer pediatric infusions in outpatient infusion centers or, as in our organization, in a hospital-based outpatient Pediatric Infusion Therapy Center (PITC). When restrictions related to the COVID-19 pandemic decreased our PITC appointment capacity by 40%, other patient and family satisfaction issues were exacerbated. We implemented a new approach to pediatric infusions with the aim of improving patient and family satisfaction and reducing the amount of time in an appointment itinerary without negatively affecting patient safety. Methods: Our team used a phased approach to pilot the administration of short chemotherapy infusions in the same outpatient clinic examination rooms where consultation and routine office visits were conducted. Patients saw their specialist for an examination and, if clinically indicated, their infusion was administered in the same room. Appointment itineraries were then completed. The team tracked efficiency, satisfaction, and safety metrics related to the new process. Results: All efficiency metrics improved. No harm came to the 49 unique patients who received a total of 184 infusions. Patient appointment itineraries were shortened by an average of 1.03 hr. Satisfaction survey responses indicated a clear preference (93%) for the new process. Discussion: The novel approach of offering short infusions in outpatient clinic examination rooms provides an opportunity to ease capacity constraints and further increase patient and family satisfaction. This method may be especially helpful for health care organizations when external influences (e.g., lack of physical space, challenging patient volumes, and pandemics) necessitate a change.

Experiencing and Forecasting COVID-19 Daily Stress on Mental Health Reactivity Across Age and Race.

OBJECTIVES: This study systematically evaluates age and race differences in mental health symptoms as they unfold microlongitudinally during the coronavirus disease 2019 (COVID-19) pandemic with a focus on within-person reactivity to forecasting and experiencing COVID-19 stress. METHOD: A daily diary approach was used to examine predictors of daily anxiety and depressive symptoms among 526 adults (White [54%] and Black American [46%]) aged 21-79. A total of 3,605 online diaries were collected for 21 consecutive days between October and November, 2020. In addition to mental health symptoms, participants reported forecasted (next 24 h) stress as well as experienced (past 24 h) stress related to COVID-19. RESULTS: Patterns of reactivity to forecasted and experienced COVID-19 stress depended on age and race. White older adults displayed greater reactivity to COVID-19-related stress than White younger adults, but the effects of COVID-19-related stress were consistently detrimental for the daily anxiety of Black Americans, regardless of age. For Black Americans, age was less negatively associated with depressive symptoms than for White Americans. Increases in experienced COVID-19 stress were also more strongly associated with increases in depressive symptoms for Black Americans relative to White participants. DISCUSSION: This study moves beyond cross-sectional, descriptive work within the context of the COVID-19 pandemic and emphasizes the dynamic nature of within-person reactivity patterns that differ by age and race. Although White older adults experienced an increase in daily anxiety when forecasting COVID-19 stress, the co-occurring pandemic of systemic racism may be more powerful than age-related vulnerabilities for Black adults.

Age Differences in Risk and Resilience Factors in COVID-19-Related Stress.

OBJECTIVES: Older adults are at higher risk for death and infirmity from COVID-19 than younger and middle-aged adults. The current study examines COVID-19-specific anxiety and proactive coping as potential risk and resilience factors that may be differentially important for younger and older adults in understanding stress experienced due to the COVID-19 pandemic. METHODS: Five hundred and fifteen adults aged 20-79 years in the United States reported on their anxiety about developing COVID-19, proactive coping, and stress related to COVID-19 in an online survey. RESULTS: Although there were no age differences in stress levels, anxiety about developing COVID-19 was associated with more COVID-19 stress for older adults relative to younger adults, but proactive coping was associated with less COVID-19 stress for older adults relative to younger adults. DISCUSSION: Our results suggest that anxiety might function as a risk factor, whereas proactive coping may function as a resilience factor for older adults' COVID-19 stress. We encourage future context-dependent investigations into mental health among older adults during this pandemic and beyond.

Mental Health Challenges of United States Healthcare Professionals During COVID-19.

As COVID-19 continues to impact global society, healthcare professionals (HCPs) are at risk for a number of negative well-being outcomes due to their role as care providers. The objective of this study was to better understand the current psychological impact of COVID-19 on HCPs in the United States This study used an online survey tool to collect demographic data and measures of well-being of adults age 18 and older living in the United States between March 20, 2020 and May 14, 2020. Measures included anxiety and stress related to COVID-19, depressive symptoms, current general anxiety, health questions, tiredness, control beliefs, proactive coping, and past and future appraisals of COVID-related stress. The sample included 90 HCPs and 90 age-matched controls (M age = 34.72 years, SD = 9.84, range = 23 - 67) from 35 states of the United States. A multivariate analysis of variance was performed, using education as a covariate, to identify group differences in the mental and physical health measures. HCPs reported higher levels of depressive symptoms, past and future appraisal of COVID-related stress, concern about their health, tiredness, current general anxiety, and constraint, in addition to lower levels of proactive coping compared to those who were not HCPs (p < 0.001, η2 = 0.28). Within the context of this pandemic, HCPs were at increased risk for a number of negative well-being outcomes. Potential targets, such as adaptive coping training, for intervention are discussed.