UTFacultiesBMSDept TPSHTSRNewsPriority Setting when Admitting Patients to the ICU During the COVID-19 Crisis

Priority Setting when Admitting Patients to the ICU During the COVID-19 Crisis A discrete choice experiment

One of the challenges faced by hospitals during the coronavirus pandemic are potential resource shortages in intensive care units. In times of scarcity, patient prioritization based on non-medical considerations might be necessary. In the course "Stakeholder Preference Elicitation and Decision Support" four students, Stephanie Schouten, Merle Gijsbers, Wietske Trompert and Iris Keizer took it upon themselves to look at the public perspective on the relevance of non-medical considerations in priority setting when admitting patients to the ICU in times of crisis. In the course, they developed a health preference instrument using discrete choice experiments. The six characteristics of the patient that were included were patient age, profession, whether or not the patient was a guardian to other people, risk-conscious behavior on a societal level (wearing masks, limiting contacts with others), health-conscious behavior (living healthy), and expected ICU length of stay. 

Twohundred and fourthythree Dutch citizens participated in the study, with a mean age of 36. In all, 70% of respondents indicated that medical and/or non-medical considerations should play a role in prioritizing patients for the ICU, whereas 15% agreed with a “first come, first served” strategy and the remaining 15% had no opinion. Respondents deemed risk-conscious behavior on a societal level to be the most important non-medical factor that should be used to prioritize patients in phase three of the framework, garnering an attribute importance of 31.2%, followed by patient age and health-conscious behavior. 

Studies like these are important create a situation of co-ownership between the public and policy makers when difficult decisions in health care have to be made. The public Dutch deemed individual responsibility as important for priority setting even though medical professionals consider this unethical and impractical. This pilot study, which was conducted during a regular course of the master program Health Sciences, provides valuable information on the trade-offs necessary for ICU priority setting, which can support future research on this ethically complex topic. By performing this study and getting it published, the students went beyond the course objectives to achieve a learning experience that is usually not achieved during a master study. We congratulate the students with their work!