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RESEARCH ARTICLE
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A survey of Australian public opinion on using comorbidity to triage intensive care patients in a pandemic

Winston Cheung A B C * , Vasi Naganathan B D , John Myburgh C E F , Manoj K. Saxena C E F , Blyth Fiona B , Ian Seppelt C G H I , Michael Parr E J , Claire Hooker AB , Ian Kerridge K , Nhi Nguyen G L , Sean Kelly L M , George Skowronski E F N , Naomi Hammond C , Antony Attokaran O , Debbie Chalmers P Q , Kalpesh Gandhi R , Mark Kol A B , Shay McGuinness Q S T , Priya Nair C E U , Vineet Nayyar V W , Neil Orford T X Y Z , Rachael Parke Q S T AA , Asim Shah A B and Atul Wagh A B
+ Author Affiliations
- Author Affiliations

A Intensive Care Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.

B Sydney Medical School – Concord, University of Sydney, Sydney, NSW, Australia.

C Critical Care and Trauma Division, The George Institute for Global Health – Australia, Newtown, NSW, Australia.

D Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia.

E Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

F Department of Intensive Care Medicine, St George Hospital, Kogarah, NSW, Australia.

G Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia.

H Sydney Medical School – Nepean, University of Sydney, Sydney, NSW, Australia.

I Australian School of Advanced Medicine, Macquarie University, NSW, Australia.

J Department of Intensive Care, Liverpool Hospital, Sydney, NSW, Australia.

K Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia.

L Intensive Care NSW, NSW Agency for Clinical Innovation, NSW, Australia.

M Intensive Care Unit, Gosford Hospital, Gosford, NSW, Australia.

N Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia.

O Intensive Care Unit, Rockhampton Hospital, Rockhampton, Qld, Australia.

P Intensive Care Unit, Hawke’s Bay Fallen Soldier’s Memorial Hospital, Hastings, New Zealand.

Q Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.

R Department of Intensive Care, Blacktown Hospital, Blacktown, Sydney, NSW, Australia.

S Medical Research Institute of New Zealand, Wellington, New Zealand.

T Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic., Australia.

U Intensive Care Unit, St. Vincent’s Hospital, Darlinghurst, NSW, Australia.

V Intensive Care Unit, Westmead Hospital, Westmead, NSW, Australia.

W Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

X Intensive Care Unit, University Hospital Geelong, Vic., Australia.

Y School of Medicine, Deakin University, Geelong, Vic., Australia.

Z Intensive Care Unit, St John of God Hospital, Geelong, Vic., Australia.

AA School of Nursing, University of Auckland, Auckland, New Zealand.

AB Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.

* Correspondence to: winston.cheung@health.nsw.gov.au

Australian Health Review https://doi.org/10.1071/AH23265
Submitted: 12 December 2023  Accepted: 15 April 2024  Published: 20 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objectives

This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers.

Methods

A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents’ fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents’ fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers.

Results

The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%).

Conclusion

Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy.

Keywords: Australia, comorbidity, COVID-19, critical care, intensive care, pandemic, public health, public opinion, survey, triage.

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