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

Ramirez, Claudia Calderon; Farmer, Yanick; Bouthillier, Marie-Ève

doi:10.1007/s44250-023-00027-9

Cited by 4 publications

(1 citation statement)

References 125 publications

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“…The social value of the individual had also been rejected in other public deliberations, for example in Thailand [ 12 ]. We believe that this value will continue to be a matter of discussion for experts and non-experts, although a tendency for its low acceptance has been observed [ 39 – 41 ].…”

Section: Discussionmentioning

confidence: 99%

What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?

Calderon Ramirez,

Farmer,

Frolic

et al. 2024

BMC Med Ethics

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Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria.

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Section: Discussionmentioning

confidence: 99%

What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?

Calderon Ramirez,

Farmer,

Frolic

et al. 2024

BMC Med Ethics

Self Cite

View full text Add to dashboard Cite

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Physician experiences of critical care triage during the COVID-19 pandemic: a scoping review

Smith,

Kulasegaran,

Cairns

et al. 2024

Discov Health Systems

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Background Coronavirus Disease 2019 (COVID-19) overwhelmed health systems globally forcing doctors to make difficult triage decisions where healthcare resources became limited. While there have been several papers surveying the views of the public surrounding triage decisions in various disasters and many academic discussions around the moral distress suffered by physicians because of this, there is little research focussed on collating the experiences of the affected physicians in the critical care setting themselves. Objective The objective of this scoping review is to consolidate the available scientific literature on triage experiences and opinions of doctors (hereby used synonymously with physicians) working in the critical care setting during the COVID-19 pandemic, particularly on issues of moral distress and the role of triage guidelines. In addition, this paper attempts to identify common themes and potential gaps related to this topic. Methods A comprehensive scoping review was undertaken informed by the process outlined by Arksey and O’Malley. Seven electronic databases were searched using keywords and database-specific MeSH terms: CINAHL, Emcare, Medline, PsychINFO, PubMed, Scopus and Web of Science. Google Scholar and references of included articles were subsequently scanned. Included studies had to have an element of data collection surveying physician experiences or opinions on triage with a critical care focus during the COVID-19 pandemic from January 2020 to June 2023. A thematic analysis was subsequently performed to consider physicians’ perspectives on triage and collate any recurrent triage concerns raised during the pandemic. Results Of the 1385 articles screened, 18 were selected for inclusion. Physicians’ perspectives were collected via two methods: interviews (40%) and surveys (60%). Sixteen papers included responses from individual countries, and collectively included: United States of America (USA), Canada, Brazil, Spain, Japan, Australia, United Kingdom (UK), Italy, Switzerland and Germany, with the remaining two papers including responses from multiple countries. Six major themes emerged from our analysis: Intensive Care Unit (ICU) preparedness for triage, role and nature of triage guidelines, psychological burden of triage, responsibility for ICU triage decision-making, conflicts in determining ICU triage criteria and difficulties with end-of-life care. Conclusions While most studies reported critical care physicians feeling confident in their clinical role, almost all expressed anxiety about the impact of their decision-making in the context of an unknown pandemic. There was general support for more transparent guidelines, however physicians differed on their views regarding level of involvement of external ethics bodies on decision-making. More research is needed to adequately investigate whether there is any link between the moral distress felt and triage guidelines. In addition, the use of an age criterion in triaging criteria and the aetiology of moral distress requires clearer consensus from physicians through further research which may help inform the legislative reform process in effectively preparing for future pandemics.

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Public perspectives on COVID-19 triage protocols for access to critical care in extreme pandemic context

Bouthillier,

Farmer,

Calderon Ramirez

et al. 2024

PLoS ONE

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COVID-19 triage protocols are resource allocation processes to deal with the potential lack of resources in Intensive Care Units (ICU). They have given rise to numerous ethical issues and controversies. Among them is the fear that people will be denied access to ICU on the basis of judgments about their quality of life, social value, frailty or age. This online Democratic Deliberation (DD) with members of the public aimed to discover the necessary considerations and conditions that make triage protocols more acceptable to guide future decisions in terms of the values and criteria that must underpin triage protocols. We simultaneously conducted the online DD in Quebec and Ontario on May 28th and June 4th, 2022, among adults who do not work in the healthcare sector, recruited randomly among the members of the public registered on Leger Opinion poll website to favor sociodemographic diversity. Data was analyzed using thematic analysis. Among the participants who took part in the study, 27 participants were from Ontario and 20 from Quebec. Three main themes emerged: 1) Acceptance of the protocol and values, 2) Considerations to be integrated in triage protocols, 3) Conditions which may favor a greater public acceptance of these protocols. Participants supported the idea of prioritizing patients with the best prognosis of survival under extreme conditions. The maximization of benefits was the most predominant approach. Participants considered that triage protocols are necessary to reduce arbitrariness in decision making and to facilitate these tragic decisions by health professionals.

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

Cited by 4 publications

References 125 publications

What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?

What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?

Physician experiences of critical care triage during the COVID-19 pandemic: a scoping review

Public perspectives on COVID-19 triage protocols for access to critical care in extreme pandemic context

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