Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas
Authors: Wilkinson D , Zohny H , Kappes A , Sinnott-Armstrong W , Savulescu J 
Published: October 2020

Objective

As 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 participants

Online 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.

Results

Seven 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.

Conclusion

Members 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.

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Article Summary

Strengths and Limitations of this study

First UK survey to investigate public attitudes to pandemic triage dilemmas

Large survey, representative of the UK general population

Enables comparison of ethical arguments and existing guidance with the views of the public

Identifies relevance of specific patient factors in concrete forced choice dilemmas: may be helpful in development or revision of triage policies

Survey findings do not allow assessment of relative weight of different factors