Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
Shopping Cart: ( empty )
You are here: Home > Journals > AH > AH23265
RESEARCH ARTICLE
Contents Vol 48(4)

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 48(4) 459-468 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.

References

1  Sztajnkrycer MD, Madsen BE, Baez AA. Unstable Ethical Plateaus and Disaster Triage. Emerg Med Clin North Am 2006; 24: 749-768.
| Crossref | Google Scholar | PubMed |

2  White DB, Katz MH, Luce JM, Lo B. Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions. Ann Intern Med 2009; 150: 132-138.
| Crossref | Google Scholar | PubMed |

3  Petrini C. Triage in public health emergencies: ethical issues. Intern Emerg Med 2010; 5: 137-144.
| Crossref | Google Scholar | PubMed |

4  Kaposy C. Accounting for Vulnerability to Illness and Social Disadvantage in Pandemic Critical Care Triage. J Clin Ethics 2010; 21: 23-29.
| Crossref | Google Scholar | PubMed |

5  Cheung W, Myburgh J, McGuinness S, Naganathan V, et al. A cross-sectional survey of Australian and New Zealand public opinion on methods to triage intensive care patients in an influenza pandemic. Crit Care Resusc 2017; 19: 254-265.
| Crossref | Google Scholar | PubMed |

6  Hui D, Park M, Liu D, Bruera E, et al. Clinical prediction of survival versus the Palliative Prognostic Score: Which approach is more accurate? Eur J Cancer 2016; 64: 89-95.
| Crossref | Google Scholar | PubMed |

7  Australian Government. Disability Discrimination Act 1992. Compilation No.33. 12 April 2018. Available at https://www.legislation.gov.au/C2004A04426/2018-04-12/text [accessed 8 May 2024].

8  Australian Government. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. 2013. Available at https://www.health.gov.au/sites/default/files/documents/2021/02/national-aboriginal-and-torres-strait-islander-health-plan-2013-2023.pdf [accessed 20 July 2023].

9  O’Toole J, Rodrigo S, Sinclair M, Leder K. The Australian Electoral Commission Roll has Good Utility for ‘niche’ household recruitment in population health studies. Aust N Z J Public Health 2009; 33: 137-139.
| Crossref | Google Scholar | PubMed |

10  Australian Electoral Commission (AEC). Supply of elector information for use in medical research. 2024. Available at http://www.aec.gov.au/Enrolling_to_vote/About_Electoral_Roll/medical_research.htm [accessed 21 September 2022].

11  Wilson JTL, Pettigrew LEL, Teasdale GM. Structured Interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for Their Use. J Neurotrauma 1998; 15: 573-585.
| Crossref | Google Scholar | PubMed |

12  Rockwood K, Song X, MacKnight C, Mitnitski A, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495.
| Crossref | Google Scholar | PubMed |

13  Preston CC, Colman AM. Optimal number of responses categories in rating scales: reliability, validity, discriminating power, and respondent preferences. Acta Psychol 2000; 104: 1-15.
| Crossref | Google Scholar | PubMed |

14  Hjermstad MJ, Fayers PM, Haugen DF, Kaasa S, et al. Studies comparing numerical rating scales, verbal rating scales and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 2011; 41: 1073-1093.
| Crossref | Google Scholar | PubMed |

15  Hyland ME, Sodergren SC. Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Qual Life Res 1996; 5: 469-480.
| Crossref | Google Scholar | PubMed |

16  Jaeschke R, Singer J, Guyatt GH. A comparison of seven-point and visual analogue scales. Control Clin Trials 1990; 11: 43-51.
| Crossref | Google Scholar | PubMed |

17  Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005; 14: 798-804.
| Crossref | Google Scholar |

18  Paul-Dauphin A, Guillemin F, Virion J-M, Briancon S. Bias and precision in visual analogue scales: a randomised controlled trial. Am J Epidemiol 1999; 150: 1117-1127.
| Crossref | Google Scholar | PubMed |

19  Perreault WD. Controlling Order-Effect Bias. Public Opin Q 1975; 39: 544-551.
| Crossref | Google Scholar |

20  Ennis L, Wykes T. Sense and readability: participant information sheets for research studies. BR J Psychiatry 2016; 208: 189-194.
| Crossref | Google Scholar | PubMed |

21  Altman DG, Bland JM. Standard deviations and standard errors. BMJ 2005; 331: 903.
| Crossref | Google Scholar | PubMed |

22  Australian Bureau of Statistics. National, state and territory population. March 2022. Data downloads – time series spreadsheets. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/mar-2022#data-download [accessed 8 November 2022].

23  Australian Bureau of Statistics. National, state and territory population. March 2022. Data downloads – data cubes. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/mar-2022#data-downloads-data-cubes [accessed 9 November 2022].

24  Perez JA, Molpeceres MA. The New Moral Power of Minorities. Int Rev Social Psychol 2018; 31: 1-10.
| Crossref | Google Scholar |

25  Holmes EC. A Philosophical Approach to the Study of Minority Problems. J Negro Educ 1969; 38: 196-203.
| Crossref | Google Scholar |

26  Centola D, Becker J, Brackbill D, Baronchelli A. Experimental evidence for tipping point in social convention. Science 2018; 360: 1116-1119.
| Crossref | Google Scholar | PubMed |

27  Norman R, Robinson S, Dickinson H, Williams I, Meshcheriakova E, Manipis K, Anstey M. Public Preferences for Allocation Ventilators in an Intensive Care Unit: A Discrete Choice Experiment. Patient 2021; 14: 319-330.
| Crossref | Google Scholar | PubMed |

28  Bellamy N, Wilson C, Hendrikz J. Population-based normative values for the Western Ontario and McMaster (WOMAC) osteoarthritis index: part I. Semin Arthritis Rheum 2011; 41: 139-148.
| Crossref | Google Scholar | PubMed |

29  Cheung W. The Triage of Adult Patients Requiring Intensive Care during Pandemics. Doctoral Dissertation, University of Sydney, Australia, University of Sydney Library - Sydney Digital Theses; 2023. Available at https://hdl.handle.net/2123/31554 [accessed 10 April 2024].