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Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

Authors: Diego S Silva, Jennifer L Gibson, Ann Robertson, Cécile M Bensimon, Sachin Sahni, Laena Maunula, Maxwell J Smith

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources.

Methods

To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis.

Results

Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues.

Conclusions

Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.
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Literature
3.
go back to reference Moineddin R, Nie J, Domb G, Leong A, Upshur R: Seasonality of primary care utilization for respiratory diseases in Ontario: a time-series analysis. BMC Health Serv Res. 2008, 8: 160-10.1186/1472-6963-8-160.CrossRefPubMedPubMedCentral Moineddin R, Nie J, Domb G, Leong A, Upshur R: Seasonality of primary care utilization for respiratory diseases in Ontario: a time-series analysis. BMC Health Serv Res. 2008, 8: 160-10.1186/1472-6963-8-160.CrossRefPubMedPubMedCentral
4.
go back to reference Crighton E, Moineddin R, Mamdani M, Upshur R: Influenza and pneumonia hospitalizations in Ontario: a time-series analysis. Epidemiol Infect. 2004, 132: 1167-1174. 10.1017/S0950268804002924.CrossRefPubMedPubMedCentral Crighton E, Moineddin R, Mamdani M, Upshur R: Influenza and pneumonia hospitalizations in Ontario: a time-series analysis. Epidemiol Infect. 2004, 132: 1167-1174. 10.1017/S0950268804002924.CrossRefPubMedPubMedCentral
5.
go back to reference Upshur R, Knight K, Goel V: Time-series analysis of the relation between influenza virus and hospital admissions of the elderly in Ontario, Canada, for pneumonia, chronic lung disease, and congestive heart failure. Am J Epidemiol. 1999, 149 (1): 85-92.CrossRefPubMed Upshur R, Knight K, Goel V: Time-series analysis of the relation between influenza virus and hospital admissions of the elderly in Ontario, Canada, for pneumonia, chronic lung disease, and congestive heart failure. Am J Epidemiol. 1999, 149 (1): 85-92.CrossRefPubMed
6.
go back to reference Silva D, Nie J, Rossiter K, Sahni S, Upshur R: Contextualizing ethics: ventilators, H1N1 and marginalized populations. Healthc Q. 2010, 13 (1): 32-36.CrossRefPubMed Silva D, Nie J, Rossiter K, Sahni S, Upshur R: Contextualizing ethics: ventilators, H1N1 and marginalized populations. Healthc Q. 2010, 13 (1): 32-36.CrossRefPubMed
7.
go back to reference Frolic A, Kata A, Kraus P: Development of a critical care triage protocol for pandemic influenza: integrating ethics, evidence and effectiveness. Healthc Q. 2009, 12 (4): 56-64.CrossRef Frolic A, Kata A, Kraus P: Development of a critical care triage protocol for pandemic influenza: integrating ethics, evidence and effectiveness. Healthc Q. 2009, 12 (4): 56-64.CrossRef
8.
go back to reference Lin J, Anderson-Shaw L: Rationing of resources: ethical issues in disasters and epidemic situations. Prehosp Disaster Med. 2009, 24 (3): 215-221.PubMed Lin J, Anderson-Shaw L: Rationing of resources: ethical issues in disasters and epidemic situations. Prehosp Disaster Med. 2009, 24 (3): 215-221.PubMed
9.
go back to reference White D, Katz M, Luce J, Lo B: Who should receive life support during a public eealth emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009, 150 (2): 132-138.CrossRefPubMedPubMedCentral White D, Katz M, Luce J, Lo B: Who should receive life support during a public eealth emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009, 150 (2): 132-138.CrossRefPubMedPubMedCentral
10.
go back to reference Powell T, Christ K, Birkhead G: Allocation of ventilators in a public health disaster. Disaster Med Public Health Prep. 2008, 2 (1): 20-26. 10.1097/DMP.0b013e3181620794.CrossRefPubMed Powell T, Christ K, Birkhead G: Allocation of ventilators in a public health disaster. Disaster Med Public Health Prep. 2008, 2 (1): 20-26. 10.1097/DMP.0b013e3181620794.CrossRefPubMed
11.
go back to reference Hick J, Rubinson L, O'Laughlin D, Farmer J: Allocating ventilators during large-scale disasters - problem, planning, and process. Crit Care. 2007, 11 (3): 217-226. 10.1186/cc5929.CrossRefPubMedPubMedCentral Hick J, Rubinson L, O'Laughlin D, Farmer J: Allocating ventilators during large-scale disasters - problem, planning, and process. Crit Care. 2007, 11 (3): 217-226. 10.1186/cc5929.CrossRefPubMedPubMedCentral
12.
go back to reference Christian M, Hawryluck L, Wax R, Cook T, Lazar N, Herridge M, et al: Development of a triage protocol for critical care during an influenza pandemic. Can Med Assoc J. 2006, 175 (11): 1377-1381. 10.1503/cmaj.060911.CrossRef Christian M, Hawryluck L, Wax R, Cook T, Lazar N, Herridge M, et al: Development of a triage protocol for critical care during an influenza pandemic. Can Med Assoc J. 2006, 175 (11): 1377-1381. 10.1503/cmaj.060911.CrossRef
13.
go back to reference Melnychuk R, Kenny N: Pandemic triage: the ethical challenge. Can Med Assoc J. 2006, 175 (11): 1393-1394. 10.1503/cmaj.061322.CrossRef Melnychuk R, Kenny N: Pandemic triage: the ethical challenge. Can Med Assoc J. 2006, 175 (11): 1393-1394. 10.1503/cmaj.061322.CrossRef
14.
go back to reference Rothstein MA: Should health care providers get treatment priority in an influenza pandemic?. J Law Med Ethics. 2010, 38: 412-419. 10.1111/j.1748-720X.2010.00499.x.CrossRefPubMedPubMedCentral Rothstein MA: Should health care providers get treatment priority in an influenza pandemic?. J Law Med Ethics. 2010, 38: 412-419. 10.1111/j.1748-720X.2010.00499.x.CrossRefPubMedPubMedCentral
16.
go back to reference Frankish C, Kwan B, Ratner P, Higgins J, Larsen C: Challenges of citizen participation in regional health authorities. Soc Sci Med. 2002, 54: 1471-1480. 10.1016/S0277-9536(01)00135-6.CrossRefPubMed Frankish C, Kwan B, Ratner P, Higgins J, Larsen C: Challenges of citizen participation in regional health authorities. Soc Sci Med. 2002, 54: 1471-1480. 10.1016/S0277-9536(01)00135-6.CrossRefPubMed
17.
go back to reference Maloff B, Bilan D, Thurston W: Enhancing public input into decision making: development of the Calgary Regional Health Authority public participation framework. Fam Community Health. 2000, 23 (1): 668-678. Maloff B, Bilan D, Thurston W: Enhancing public input into decision making: development of the Calgary Regional Health Authority public participation framework. Fam Community Health. 2000, 23 (1): 668-678.
18.
go back to reference Daniels N, Sabin J: Setting Limits Fairly: Can We Learn to Share Resources for Health. 2008, New York: Oxford University Press, 2 Daniels N, Sabin J: Setting Limits Fairly: Can We Learn to Share Resources for Health. 2008, New York: Oxford University Press, 2
19.
go back to reference Cox SM, Kazubowski-Houston M, Nisker J: Genetics on stage: public engagement in health policy development on preimplantation genetic diagnosis. Soc Sci Med. 2009, 68 (8): 1472-1480. 10.1016/j.socscimed.2009.01.044.CrossRefPubMed Cox SM, Kazubowski-Houston M, Nisker J: Genetics on stage: public engagement in health policy development on preimplantation genetic diagnosis. Soc Sci Med. 2009, 68 (8): 1472-1480. 10.1016/j.socscimed.2009.01.044.CrossRefPubMed
20.
go back to reference Secko DM, Preto N, Niemeyer S, Burgess MM: Informed consent in biobank research: a deliberative approach to the debate. Soc Sci Med. 2009, 68 (4): 781-789. 10.1016/j.socscimed.2008.11.020.CrossRefPubMed Secko DM, Preto N, Niemeyer S, Burgess MM: Informed consent in biobank research: a deliberative approach to the debate. Soc Sci Med. 2009, 68 (4): 781-789. 10.1016/j.socscimed.2008.11.020.CrossRefPubMed
22.
go back to reference Perhac R: Comparative risk assessment: where does the public fit in?. Sci Technol Hum Val. 1998, 23 (2): 221-241. 10.1177/016224399802300204.CrossRef Perhac R: Comparative risk assessment: where does the public fit in?. Sci Technol Hum Val. 1998, 23 (2): 221-241. 10.1177/016224399802300204.CrossRef
23.
go back to reference Gross A: The roles of rhetoric in the public understanding of science. Public Underst Sci. 1994, 3: 3-23. 10.1088/0963-6625/3/1/001.CrossRef Gross A: The roles of rhetoric in the public understanding of science. Public Underst Sci. 1994, 3: 3-23. 10.1088/0963-6625/3/1/001.CrossRef
25.
go back to reference Thompson AK, Faith K, Gibson JL, Upshur REG: Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics. 2006, 7: 12-10.1186/1472-6939-7-12.CrossRefPubMedCentral Thompson AK, Faith K, Gibson JL, Upshur REG: Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics. 2006, 7: 12-10.1186/1472-6939-7-12.CrossRefPubMedCentral
27.
go back to reference Cetron M, Landwirth J: Public health and ethical considerations in planning for quarantine. Yale J Biol Med. 2005, 78: 325-330. Cetron M, Landwirth J: Public health and ethical considerations in planning for quarantine. Yale J Biol Med. 2005, 78: 325-330.
28.
go back to reference Lincoln YS, Guba E: Naturalistic Inquiry. 1985, London: Sage Publications Lincoln YS, Guba E: Naturalistic Inquiry. 1985, London: Sage Publications
29.
go back to reference Ritvo P, Wilson K, Gibson JL, Guglietti C, Tracy SC, Nie JX, Jadad AR, Upshur RE: Canadian survey on pandemic flu preparations. BMC Public Health. 2010, 10: 125-CrossRefPubMedPubMedCentral Ritvo P, Wilson K, Gibson JL, Guglietti C, Tracy SC, Nie JX, Jadad AR, Upshur RE: Canadian survey on pandemic flu preparations. BMC Public Health. 2010, 10: 125-CrossRefPubMedPubMedCentral
30.
go back to reference Cookson R, Dolan P: Public views on health care rationing: a group discussion study. Health Policy. 1999, 49 (1-2): 63-74. 10.1016/S0168-8510(99)00043-3.CrossRefPubMed Cookson R, Dolan P: Public views on health care rationing: a group discussion study. Health Policy. 1999, 49 (1-2): 63-74. 10.1016/S0168-8510(99)00043-3.CrossRefPubMed
31.
go back to reference Mitton C, Smith N, Peacock S, Evoy B, Abelson J: Public participation in health care priority setting: a scoping review. Health Policy. 2009, 91: 219-228. 10.1016/j.healthpol.2009.01.005.CrossRefPubMed Mitton C, Smith N, Peacock S, Evoy B, Abelson J: Public participation in health care priority setting: a scoping review. Health Policy. 2009, 91: 219-228. 10.1016/j.healthpol.2009.01.005.CrossRefPubMed
32.
go back to reference Bombard Y, Abelson J, Simeonov D, Gauvin FP: Eliciting ethical and social values in health technology assessment: a participatory approach. Soc Sci Med. 2011, 73 (1): 135-144. 10.1016/j.socscimed.2011.04.017.CrossRefPubMed Bombard Y, Abelson J, Simeonov D, Gauvin FP: Eliciting ethical and social values in health technology assessment: a participatory approach. Soc Sci Med. 2011, 73 (1): 135-144. 10.1016/j.socscimed.2011.04.017.CrossRefPubMed
Metadata
Title
Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives
Authors
Diego S Silva
Jennifer L Gibson
Ann Robertson
Cécile M Bensimon
Sachin Sahni
Laena Maunula
Maxwell J Smith
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-241

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