65 COGNITIVE HEALTH AND ETHICAL CHALLENGES IN HEALTHCARE DECISION-MAKING IN A SPECIAL GROUP OF SCHIZOPHRENIC PATIENTS STUDY
Authors: Chen Ang , Wang* Zhenyu 
Published: February 2025

Abstract

Background
In the clinical management of schizophrenia, patients belonging to special populations, including the elderly, adolescents, and those with comorbid conditions, often face unique challenges. These challenges extend beyond the diagnosis and treatment of the disease to include impairments in cognitive functions that affect memory, attention, and executive functions, thereby impacting their daily living and work capabilities. Ethical issues are particularly prominent in the medical decision-making process, especially when dealing with informed consent, respecting patient autonomy, and safeguarding the best interests of the patient. For these special populations, balancing these ethical principles to ensure appropriate treatment and care is particularly urgent. Therefore, the study aims to address the cognitive health and ethical issues in medical decision-making for special populations of schizophrenia patients.

Methods
The study employed a mixed-methods approach, combining quantitative analysis of cognitive health indicators with qualitative assessment of ethical challenges in medical decision-making. The study included 150 schizophrenia patients from a specialized psychiatric clinic, with a focus on the elderly (aged 60 and above). Cognitive health was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Ethical challenges were evaluated through semi-structured interviews with patients, caregivers, and healthcare providers.

Results
Quantitative analyses showed that a special group of schizophrenics showed significant impairments in all seven cognitive domains of the MCCB compared to the normal population. In terms of assessing the speed at which things are done, the average score of the patients was 58.3±12.4, which was significantly different from the normal population (P&lt;0.001). For working memory, the average score of the patients was 52.1±10.8, again significantly different from the normal population (P&lt;0.001). The average score for executive functions in the patient group was 49.5±11.2, which was significantly different from the normal population (P&lt;0.001). Qualitative analysis revealed ethical challenges faced in medical decision-making, including the difficulty of obtaining informed consent, balancing patient autonomy with the necessity of medical intervention, and the impact of comorbidities on treatment choices. Additionally, the study found significant differences in healthcare utilization and costs among special populations. The average healthcare utilization rate for the special population was 42.6%, lower than the general population’s 58.9% (P&lt;0.05). The average annual cost of healthcare for the special population was $12,345, higher than the general population’s $9,876 (P&lt;0.05).

Discussion
The study results emphasize the importance of cognitive health interventions for special populations of schizophrenia patients. The presence of cognitive impairments and ethical challenges in medical decision-making require healthcare providers to adopt more nuanced and personalized approaches. The findings also indicate the need for improved healthcare policies to ensure that all schizophrenia patients receive high-quality medical services, regardless of their special population status. Furthermore, the study calls for more education and training on ethical issues in the medical decision-making process to enhance the ability of healthcare providers to handle complex ethical dilemmas.

Funding
No. 2024ZSMS121.