Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas

Abstract

AbstractObjectiveAs cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICU) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help inform triage guidance by exploring the view of lay people about factors to include in triage decisions.Design, setting and participantsOnline survey between 29thMay and 22ndJune 2020 based on hypothetical triage dilemmas. Participants recruited from existing market research panels, representative of the UK general population. Scenarios were presented in which a single ventilator is available, and two patients require ICU admission and ventilation. Patients differed in one of: chance of survival, life expectancy, age, expected length of treatment, disability, and degree of frailty. Respondents were given the option of choosing one patient to treat, or tossing a coin to decide.ResultsSeven hundred and sixty-three participated. A majority of respondents prioritized patients who would have a higher chance of survival (72-93%), longer life expectancy (78-83%), required shorter duration of treatment (88-94%), were younger (71-79%), or had a lesser degree of frailty (60-69% all p< .001). Where there was a small difference between two patients, a larger proportion elected to toss a coin to decide which patient to treat. A majority (58-86%) were prepared to withdraw treatment from a patient in intensive care who had a lower chance of survival than another patient currently presenting with COVID-19. Respondents also indicated a willingness to give higher priority to healthcare workers and to patients with young children.ConclusionMembers of the UK general public potentially support a broadly utilitarian approach to ICU triage in the face of overwhelming need. Survey respondents endorsed the relevance of patient factors currently included in triage guidance, but also factors not currently included. They supported the permissibility of reallocating treatment in a pandemic.BMJI, the Submitting Author has the right to grant and does grant on behalf of all authors of the Work (as defined in the below author licence), an exclusive licence and/or a non-exclusive licence for contributions from authors who are: i) UK Crown employees; ii) where BMJ has agreed a CC-BY licence shall apply, and/or iii) in accordance with the terms applicable for US Federal Government officers or employees acting as part of their official duties; on a worldwide, perpetual, irrevocable, royalty-free basis to BMJ Publishing Group Ltd (“BMJ”) its licensees and where the relevant Journal is co-owned by BMJ to the co-owners of the Journal, to publish the Work in this journal and any other BMJ products and to exploit all rights, as set out in ourlicence.The Submitting Author accepts and understands that any supply made under these terms is made by BMJ to the Submitting Author unless you are acting as an employee on behalf of your employer or a postgraduate student of an affiliated institution which is paying any applicable article publishing charge (“APC”) for Open Access articles. Where the Submitting Author wishes to make the Work available on an Open Access basis (and intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative Commons licence – details of these licences and whichCreative Commonslicence will apply to this Work are set out in our licence referred to above.Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate material already published. I confirm all authors consent to publication of this Work and authorise the granting of this licence.Article SummaryStrengths and Limitations of this studyFirst UK survey to investigate public attitudes to pandemic triage dilemmasLarge survey, representative of the UK general populationEnables comparison of ethical arguments and existing guidance with the views of the publicIdentifies relevance of specific patient factors in concrete forced choice dilemmas: may be helpful in development or revision of triage policiesSurvey findings do not allow assessment of relative weight of different factors