Opinions on Scare Resource Allocation Policy Exemptions and Adjustments Among Laypeople and Healthcare Workers by License Type

ABSTRACT

Introduction: COVID-19 magnified the importance of health systems' readiness for scarce resource allocation during times of potential crisis-related shortages. Understanding how ethical values of laypeople differ from that of healthcare workers (HCW) is crucial to ensure a widely accepted policy. We intended to better understand how the values of laypeople, licensed independent practitioners (LIP), and non-LIP HCW align and differ regarding scarce resource allocation, particularly on exemptions and adjustments to ICU triage decisions, which could otherwise undermine public trust if not appropriately understood. Methods: Data were collected from a web-based national survey aimed at understanding the effects of the COVID-19 pandemic. We analyzed 1934 adult respondents, including 1353 lay-people, 200 LIPs and 381 non-LIP HCW. Respondents' values were assessed by 9- point Likert scale, (1= should be less likely to receive, 5 = should not influence, 9 = should be much more likely to receive ICU care), comparing responses using Kruskal-Wallis tests. Results: All groups equally prioritized ICU care for pregnant persons in first trimester. Agreement on prioritization was stronger for 3rd trimester pregnancy, where LIP rated agreement higher than other HCW (P=0.020). Laypeople favored a principle of reciprocity, prioritizing front-line health workers more than either LIP or other HCW (8 vs 7 vs 6, respectively, P<0.001). Laypersons rated their trust that health systems would apply SRA policy in a fair and consistent way slightly lower compared to either LIP or other HCW, but this was not significant (6 vs 7 vs 7, P=0.5). All groups felt similarly anxious and worried when thinking about policies like this (median score 7 where 9 = “I feel very anxious when thinking about this”, P=0.9). Discussion/Conclusions: In creating policies for scarce resource allocation, it is important to consider the nuanced values of all groups affected by these policies. In particular, while concern may exist that systems using non-healthrelated factors in treatment decisions may be less agreeable, we found similar levels of agreement when prioritizing on two key groups pregnancy and at-risk health worker status. While our survey showed all groups lean towards trusting the healthcare system to fairly allocate resources, the range of responses and the consistent anxiety surrounding these policies emphasizes the importance of trying to understand and accommodate the priorities of affected groups as able. (Table Presented).