Public Preferences in Priority Setting when Admitting Patients to the ICU During the COVID-19 Crisis: A Pilot Study

Abstract

Introduction One of the challenges faced by hospitals during the coronavirus disease 2019 (COVID-19) pandemic is resource shortages in intensive care units (ICUs). In times of scarcity, patient prioritization based on non-medical considerations might be necessary. Objective The aim of this study was to pilot test a survey to elicit public opinions on the relative importance of non-medical considerations in priority setting when admitting patients to the ICU in times of crisis. Methods A discrete-choice experiment was used to collect social preferences for priority setting when admitting patients to the ICU during the COVID-19 pandemic. The six attributes were patient age, profession, guardianship, risk-conscious behavior on a societal level, health-conscious behavior, and expected ICU length of stay. The data were analyzed using a mixed multinomial logit model. Interactions between the age and profession of the respondents and the age and profession of the patient profiles were considered. Results The mean (± standard deviation) age of respondents was 35.9 ± 14.5 years. In all, 70% of respondents indicated that medical and/or non-medical considerations should play a role in prioritizing patients for the ICU, whereas 15% agreed with a "first come, first served" strategy and the remaining 15% had no opinion. Respondents deemed risk-conscious behavior on a societal level to be the most important non-medical factor that should be used to prioritize patients in phase three of the framework, garnering an attribute importance (AI) of 31.2%, followed by patient age (AI 16.3%) and health-conscious behavior (AI 16.0%). ICU length of stay had the lowest impact on patient prioritization for ICU admittance (AI 10.9%). Younger and older respondents attached more importance to age than respondents in the middle age group and indicated a stronger preference to prioritize patients in their own age group (p = 0.042). ConclusionThe results of our study demonstrate the relative importance members of the public attach to responsible societal behavior during the COVID-19 pandemic. In the next phase of the study, we will elicit the perspectives of a representative sample of the Dutch population. Changes to the task design and attribute operationalization could improve the external validity of the study findings, and optimization of the experimental design will improve the internal validity of the study.

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

“…Another study included participants from both the USA and Canada [41]. Other studies conducted public consultation with a speci c population: 4 studies from the USA [42,43,44,45]; 3 from the UK [46, 47, 48]; 2 from Iran [49,50]; 2 from Australia [51,52]; 1 study from each of the following countries: Italy [53], Switzerland [54], Netherlands [55]; Portugal [56], Thailand [57], Japan [58], and Korea [59].…”

Applications of discrete choice experiments in COVID-19 research: Disparity in survey qualities between health and transport fields

“…Examination of the topics of health-related experiments revealed that the topic of these experiments could each identify with one of these five major themes. This includes, in the order of their frequency, preferences for (1) vaccine attributes ( Borriello et al, 2021 ; Craig, 2021 ; Dong et al, 2020 ; Eshun-Wilson et al, 2021b ; Hess et al, 2022 ; Huang et al, 2021 ; Kreps et al, 2020 ; Leng et al, 2021 ; Li et al, 2021b ; Liu et al, 2021a ; Luevano et al, 2021 ; McPhedran and Toombs, 2021 ; Schwarzinger et al, 2021 ) (2) non-pharmaceutical preventative measures such as stay at home, social distancing, surveillance and contact tracing policies ( Degeling et al, 2020 ; Eshun-Wilson et al, 2021a ; Genie et al, 2020 ; Jonker et al, 2020 ; Li et al, 2021a ; Mouter et al, 2021 ; Rad et al, 2021 ), (3) restriction lifting/relaxation policies and exit strategies ( Chorus et al, 2020 ; Krauth et al, 2021 ; Reed et al, 2020 ), (4) allocation of limited medical resources and the associated dilemmas (e.g., ICU capacities, vaccines) ( Gijsbers et al, 2021 ; Luyten et al, 2021 ; Michailidou, 2021 ) and (5) diagnostic and testing methods ( Katare et al, 2022 ; Liu et al, 2021b ). Fig.…”

“…They may have personal desires, for example, for lockdowns or social distancing restrictions to be lifted, but may mask that preference during the survey in favour of options that they perceive more socially acceptable, such as those that indicate that they are willing to make financial sacrifices in order to save lives ( Chorus et al, 2020 ). Same goes with experiments that pose trade-offs in terms of the allocation of vital but limited medical resources, such as vaccine or ICU bed prioritisation ( Gijsbers et al, 2021 ; Michailidou, 2021 ). The survey of Michailidou (2021) , for example, found that participants’ response often violated optimal allocation of resources to benefit female patients with respect to hospital bed allocation or that respondents were less likely to allocate resources to higher income groups, while also showing no signs of racial bias.…”

“…The hypothetical choice questions put to respondents in certain pandemic-related surveys poses certain social dilemmas to them ( Chorus et al, 2020 ; Gijsbers et al, 2021 ; Luyten et al, 2021 ; Michailidou, 2021 ). In such circumstances it is plausible to assume that respondents may engage in type of responses that depicts a more socially desirable picture of them.…”

“…An important dimension that was not particularly analysed in this review was the type of survey instrument used by studies. A large number of studies (particularly in health) ( Craig, 2021 ; Eshun-Wilson et al, 2021b ; Genie et al, 2020 ; Gijsbers et al, 2021 ; Katare et al, 2022 ; Li et al, 2021a ) reported on administering their surveys through major survey platforms such as Qualtrics, sampling from the panel of respondents of those companies. Web-based survey tools often provide flexibility to randomize question order and cost-effectively select targeted populations.…”