What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?
Abstract Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-03-01
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| Series: | BMC Medical Ethics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12910-024-01030-2 |
| _version_ | 1797247038461575168 |
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| author | Claudia Calderon Ramirez Yanick Farmer Andrea Frolic Gina Bravo Nathalie Orr Gaucher Antoine Payot Lucie Opatrny Diane Poirier Joseph Dahine Audrey L’Espérance James Downar Peter Tanuseputro Louis-Martin Rousseau Vincent Dumez Annie Descôteaux Clara Dallaire Karell Laporte Marie-Eve Bouthillier |
| author_facet | Claudia Calderon Ramirez Yanick Farmer Andrea Frolic Gina Bravo Nathalie Orr Gaucher Antoine Payot Lucie Opatrny Diane Poirier Joseph Dahine Audrey L’Espérance James Downar Peter Tanuseputro Louis-Martin Rousseau Vincent Dumez Annie Descôteaux Clara Dallaire Karell Laporte Marie-Eve Bouthillier |
| author_sort | Claudia Calderon Ramirez |
| collection | DOAJ |
| description | Abstract Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. |
| first_indexed | 2024-04-24T19:52:20Z |
| format | Article |
| id | doaj.art-fe5fd844e67340678401d850c7ad8f28 |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-04-24T19:52:20Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-fe5fd844e67340678401d850c7ad8f282024-03-24T12:33:04ZengBMCBMC Medical Ethics1472-69392024-03-0125111410.1186/s12910-024-01030-2What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?Claudia Calderon Ramirez0Yanick Farmer1Andrea Frolic2Gina Bravo3Nathalie Orr Gaucher4Antoine Payot5Lucie Opatrny6Diane Poirier7Joseph Dahine8Audrey L’Espérance9James Downar10Peter Tanuseputro11Louis-Martin Rousseau12Vincent Dumez13Annie Descôteaux14Clara Dallaire15Karell Laporte16Marie-Eve Bouthillier17Biomedical Sciences Program, Clinical Ethics, Faculty of Medicine, Université de MontréalDepartment of Social and Public Communication, Faculty of Communication, succursale Centre-Ville, Université du Québec à MontréalProgram for Ethics and Care Ecologies (PEaCE), Hamilton Health Sciences – King WestDepartment of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de SherbrookeResearch Centre of the Sainte-Justine University HospitalOffice of Clinical Ethics, Faculty of Medicine, Université de Montréal, Pavillon Roger-GaudryExecutive Office Administration, Faculty of Medicine, McGill University Health CentreCIUSSS du Centre-Sud-de-l‘Île-de-MontréalDepartment of Medicine and Medical Specialties, Faculty of Medicine, Université de MontréalÉcole nationale d’administration publique (ENAP)Division of Palliative Care, Department of Medicine, University of OttawaOttawa Hospital Research InstituteFaculty of Engineering, Montreal PolytechnicCentre d’Excellence sur le Partenariat avec les Patients et le Public (CEPPP) CRCHUM –Bureau du Patient Partenaire, Faculté de médecine, Université de MontréalBureau du Patient Partenaire, Faculté de médecine, Université de MontréalMedical residency program, Faculty of Medicine, Université de MontréalOffice of Clinical Ethics, Faculty of Medicine, Université de Montréal, Pavillon Roger-GaudryAbstract Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria.https://doi.org/10.1186/s12910-024-01030-2COVID-19 prioritizationTiebreakersCritical careDemocratic deliberationClinical ethics |
| spellingShingle | Claudia Calderon Ramirez Yanick Farmer Andrea Frolic Gina Bravo Nathalie Orr Gaucher Antoine Payot Lucie Opatrny Diane Poirier Joseph Dahine Audrey L’Espérance James Downar Peter Tanuseputro Louis-Martin Rousseau Vincent Dumez Annie Descôteaux Clara Dallaire Karell Laporte Marie-Eve Bouthillier What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? BMC Medical Ethics COVID-19 prioritization Tiebreakers Critical care Democratic deliberation Clinical ethics |
| title | What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? |
| title_full | What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? |
| title_fullStr | What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? |
| title_full_unstemmed | What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? |
| title_short | What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? |
| title_sort | what are the views of quebec and ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a covid 19 pandemic |
| topic | COVID-19 prioritization Tiebreakers Critical care Democratic deliberation Clinical ethics |
| url | https://doi.org/10.1186/s12910-024-01030-2 |
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