ABSTRACT
RATIONALE: There is controversy regarding which factors should guide resource allocation decisions during triage. Healthcare professionals' different roles and experiences may influence their beliefs and be relevant to development and implementation of triage protocols. We therefore sought to compare views of healthcare professionals in different roles on how strongly various health factors should influence patients' likelihood of receiving life-support in triage. METHODS: Secondary analysis of UC-COVID data. We analyzed responses from an online volunteer sample of 1,935 adult participants, including 582 healthcare professionals (HCPs) recruited from community organizations and direct media messaging. The survey was fielded from May-September, 2020. The main outcome measures were how likely patients should be to receive life support, rated on a Likert scale, from 1 (should be much less likely) to 9 (should be much more likely). Responses were combined into terciles with 1-3 coded as “deprioritized”, 4-6 as “neither deprioritized or prioritized” and 7-9 as “prioritized”. Health factors assessed included patients who (1) are deemed less likely to survive, (2) have shorter expected lifespans due to chronic illness, (3) are elderly, and (4) are children. Differences between healthcare groups were assessed using Pearson's chi-squared test. RESULTS: Of the 582 HCPs, 26% identified as physicians, 8% as advanced practice providers (including, nurse practitioners, physician's assistants, or other), 33% as primary bedside providers (including nurses, medical assistants, or respiratory therapists), and 33% as some other HCP. A majority of physicians (75%), advance practice providers (67%) and primary bedside providers (64%) deprioritized patients deemed less likely to survive compared to a minority of other HCPs (46%, p<.0001). A minority in each group deprioritized patients with shorter expected lifespans due to chronic illness, but physicians were more likely to deprioritize (49%) compared to advance practice providers (42%), primary bedside providers (37%), and other HCPs (20%, p<.0001). Fewer than 25% in all groups deprioritized patients who are elderly physicians (23%), advance practice providers (24%), primary bedside providers (18%), and other HCPs (11%, p=0.046). Less than 10% in any group thought children should be deprioritized (p=0.20). CONCLUSIONS:There was broad agreement among all groups that children and the elderly should not be deprioritized in triage decisions. There was more disagreement on how to prioritize patients deemed less likely to survive or patients with shorter expected lifespans due to chronic illness. It was also notable that physicians more often deprioritized based on these health factors compared to other groups.
ABSTRACT
BACKGROUND: There is controversy over which factors should guide resource allocation decisions during crises. Healthcare professionals (HCP) and general public's different experiences may influence beliefs and be relevant to development and implementation of triage protocols. We compared HCPs and the public's views on how health factors should influence patients' likelihood of receiving life-support in triage. METHODS: Secondary analysis of UC-COVID data. We analyzed responses from 1,167 adult participants, recruited via community organizations and social media. The survey was fielded May-September 2020. Main outcome measures were how likely patients should be to receive life support, rated on a Likert scale from 1 (should be much less likely) to 9 (should be much more likely). Responses were collapsed into terciles: 1-3 coded “deprioritized”, 4-6 “neither deprioritized nor prioritized” and 7-9 “prioritized”. Factors assessed included patients who (1) are deemed less likely to survive, (2) have shorter expected lifespans due to chronic illness, (3) are elderly, and (4) are children. Multinomial logistic regression models were fit for each factor. RESULTS: 31% of participants were HCPs. 21% were between 18-34 years old, 33% were 35-49, 28% were 50-64, and 18% were ≥65. HCPs were younger than the public [Median (IQR) 40 (34;54) vs 51 (37;63), P<.0001]. In adjusted analyses controlling for sociodemographic factors, 65% of HCPs deprioritized patients deemed less likely to survive compared to 48% of the public (P<.0001). Most respondents (55% HCP vs 73% public) neither prioritized nor deprioritized patients with shorter life expectancy, but HCPs more often deprioritized (36% vs 21%, p<.0001). A majority of HCPs (72%) and public (74%) neither prioritized nor deprioritized older patients. Nearly 1/3 of respondents neither prioritized nor deprioritized children (32% HCPs vs 34% public) and almost 2/3 prioritized children (64% HCPs vs 65% public) CONCLUSIONS: HCPs were more likely than the public to deprioritize patients deemed less likely to survive and with shorter expected lifespans. A majority of HCPs and the public indicated both that older patients should not be deprioritized, and that children should be prioritized.