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

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. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]