We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation.
- Authors
Buhr, Russell G.; Huynh, Ashley; Lee, Connie; Nair, Vishnu P.; Romero, Ruby; Wisk, Lauren E.
- Abstract
This survey study evaluates whether community members and health care professionals agree with scarce resource allocation protocols developed in a US healthcare system. Key Points: Question: What are the opinions and values of key informants among both laypersons and health care professionals regarding the design and implementation of scarce resource allocation (SRA) policy under crisis standards of care? Findings: This survey study of 1545 participants found moderate agreement with policy tenets from the University of California SRA policy. Health care professionals agreed more strongly with both prioritizing resources for and reallocating existing resources to those most likely to survive. Meaning: These findings suggest common SRA policy tenets are broadly acceptable to both laypersons and health care professionals, though substantial disagreement on logistics of implementation remains. Importance: COVID-19 prompted rapid development of scarce resource allocation (SRA) policies to be implemented if demand eclipsed health systems' ability to provide critical care. While SRA policies follow general ethical frameworks, understanding priorities of those affected by policies and/or tasked with implementing them is critical. Objective: To evaluate whether community members and health care profesionals (HCP) agree with SRA protocols at the University of California (UC). Design, Setting, and Participants: This survey study used social media and community-partnered engagement to recruit participants to a web-based survey open to all participants aged older than 18 years who wished to enroll. This study was fielded between May and September 2020 and queried participants' values and preferences on draft SRA policy tenets. Participants were also encouraged to forward the survey to their networks for snowball sampling. Data were analyzed from July 2020 to January 2024. Main Outcomes and Measures: Survey items assessed values and preferences, graded on Likert scales. Agreement was tabulated as difference in Likert points between expressed opinion and policy tenets. Descriptive statistics were tested for significance by HCP status. Free text responses were analyzed using applied rapid qualitative analysis. Results: A total of 1545 participants aged older than 18 years (mean [SD] age 49 [16] years; 1149 female participants [74%], 478 health care practitioners [30%]) provided data on SRA values and preferences. Agreement with UC SRA policy as drafted was moderately high among respondents, ranging from 67% to 83% across domains. Higher agreement with the interim policy was observed for laypersons across all domains except health-related factors. HCPs agreed more strongly on average that resources should not be allocated to those less likely to survive (HCP mean, 3.70; 95% CI, 3.16-3.59; vs layperson mean, 3.38; 95% CI, 3.17-3.59; P =.002), and were more in favor of reallocating life support from patients less likely to those more likely to survive (HCP mean, 6.41; 95% CI, 6.15-6.67; vs layperson mean, 5.40; 95% CI, 5.23-5.58; P <.001). Transparency and trust building themes were common in free text responses and highly rated on scaled items. Conclusions and Relevance: This survey of SRA policy values found moderate agreement with fundamental principles of such policies. Engagement with communities affected by SRA policy should continue in iterative refinement in preparation for future crises.
- Subjects
CALIFORNIA; MEDICAL protocols; COMMUNITY support; SCALE analysis (Psychology); SOCIAL media; RESOURCE allocation; QUALITATIVE research; RESEARCH funding; MEDICAL personnel; UNIVERSITIES &; colleges; HEALTH policy; STATISTICAL sampling; PUBLIC opinion; DESCRIPTIVE statistics; SURVEYS; ATTITUDES of medical personnel; RESOURCE-limited settings; CONFIDENCE intervals; VALUES (Ethics); PSYCHOSOCIAL factors; MEDICAL ethics
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe241958
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.1958