Who Gets the Last Bed? A Discrete-Choice Experiment Examining General Population Preferences for Intensive Care Bed Prioritization in a Pandemic

Abstract

Objective To explore the key patient attributes important to members of the Australian general population when prioritizing patients for the final intensive care unit (ICU) bed in a pandemic over-capacity scenario. Methods A discrete-choice experiment administered online asked respondents ( N = 306) to imagine the COVID-19 caseload had surged and that they were lay members of a panel tasked to allocate the final ICU bed. They had to decide which patient was more deserving for each of 14 patient pairs. Patients were characterized by 5 attributes: age, occupation, caregiver status, health prior to being infected, and prognosis. Respondents were randomly allocated to one of 7 sets of 14 pairs. Multinomial, mixed logit, and latent class models were used to model the observed choice behavior. Results A latent class model with 3 classes was found to be the most informative. Two classes valued active decision making and were slightly more likely to choose patients with caregiving responsibilities over those without. One of these classes valued prognosis most strongly, with a decreasing probability of bed allocation for those 65 y and older. The other valued both prognosis and age highly, with decreasing probability of bed allocation for those 45 y and older and a slight preference in favor of frontline health care workers. The third class preferred more random decision-making strategies. Conclusions For two-thirds of those sampled, prognosis, age, and caregiving responsibilities were the important features when making allocation decisions, although the emphasis varies. The remainder appeared to choose randomly.

Hospital saturation and risk of death without receiving mechanical ventilation in hospitalized COVID-19 patients: a city-wide analysis

“…Interestingly, a recent survey among physicians put good prognosis, lower age, and having caregiving responsibilities among the main criteria to account for when choosing who gets the last ICU bed. 31 When proposed with several methods to choose who gets the last bed, most chose to use a pre-established set of rules by the health department or chose to defer the decision to the senior physician. 31…”

“…31 When proposed with several methods to choose who gets the last bed, most chose to use a pre-established set of rules by the health department or chose to defer the decision to the senior physician. 31…”

Route selection method with ethical considerations for automated vehicles under critical situations

“…Under critical situations, which necessarily leads to serious or fatal injury, the random choice on the selected route is ethically established. Clinical therapies pose similar challenge, when random choice is part of decision under critical situations, see e.g., [34], [35]. Consequently, random choice is selected for route selection only, but only in these critical situations.…”

Service-level barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use: protocol for a scoping review

“…The available literature on individual preferences in the context of the pandemic has focused almost entirely on vaccinations, [28][29][30][31] public health measures [32][33][34] and resource allocation. 35 We propose to conduct a scoping review to address the gap related to individual preferences for SUHSs for the treatment of AUD/PAU by identifying characteristics of the services that affect access to them, based on the perspectives of individuals with current or past AUD or PAU and those who deliver treatment services (eg, clinicians, other care providers and administrators). Findings from this review will highlight service-level factors in which changes are most likely to result in improved access to SUHSs for the treatment of AUD/PAU in general, as well as in pandemic circumstances.…”

“…However, little is known about how the COVID-19 pandemic may affect preferences for the utilisation of SUHSs for the treatment of AUD or PAU. The available literature on individual preferences in the context of the pandemic has focused almost entirely on vaccinations,28–31 public health measures32–34 and resource allocation 35. We propose to conduct a scoping review to address the gap related to individual preferences for SUHSs for the treatment of AUD/PAU by identifying characteristics of the services that affect access to them, based on the perspectives of individuals with current or past AUD or PAU and those who deliver treatment services (eg, clinicians, other care providers and administrators).…”