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Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural Epublish 4 citations

PubMed: 38470416 DOI: 10.1001/jamanetworkopen.2024.1958

Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation.

JAMA Netw Open 7(3):e241958

Authors: Russell G Buhr, Ashley Huynh, Connie Lee, Vishnu P Nair, Ruby Romero, Lauren E Wisk

Affiliations

  • Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles.
  • Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
  • Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles.
  • Clinical and Translational Science Institute Research Associates Program, University of California, Los Angeles.
  • University of California Irvine School of Medicine, Irvine.
  • Keck Graduate Institute School of Pharmacy and Health Sciences, Claremont, California.
  • David Geffen School of Medicine, University of California, Los Angeles.
  • Department of Medicine, Stanford University, Stanford, California.
  • Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles.

Abstract

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.

MeSH

Resource Allocation, Aged, Clinical Medicine

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