Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation

This survey study evaluates whether community members and health care professionals agree with scarce resource allocation protocols developed in a US healthcare system.

eTable 1. Questions From the UC-COVID Survey With Scaling and Sampling Universe Section 1: Values surrounding logistics of SRA policy Section Scaling 10-point Likert: I strongly disagree with this (1) to I strongly agree with this (10) or I'd prefer not to answer

Universe
Question Prompt Text Proportion not answered

HCP Header
If there are not enough ventilators or other critical care resources for everyone during a crisis, hospitals and health care workers may need to make decisions about who to give those resources to first.
Again, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as ventilators, dialysis machines, ECMO circuits, other supplies, medications, or staff) to care for everyone who needs these resources, and some people will die without these resources.
Please tell us how you feel hospitals and health care workers should make decisions like these in general. ---

Non-HCP Header
If there are not enough ventilators or other critical care resources for everyone during a crisis, hospitals and health care workers may need to make decisions about who to give those resources to first.
Again, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as ventilators, dialysis machines, ECMO circuits, other supplies, medications, or staff) to care for everyone who needs these resources, and some people will die without these resources.
Please tell us how you feel hospitals and health care workers should make decisions like these in general. ---

ALL
They should try to save the most number of lives possible 1.4% ALL They should take life support away from some patients in order to give it to other patients who are more likely to survive 5.9%

ALL
They should make decisions on a first-come, first-served basis 3.8% ALL They should apply the same rules to decide who gets life support to all patients equally 2.9%

ALL
The same rules should apply to all patients even if they were admitted to the hospital before the crisis started 4.5%

ALL
The same rules should apply to all patients even if they're in the hospital for reasons that aren't related to the disaster or pandemic 4.1%

ALL
Hospital committees (instead of individual doctors) should make these decisions 4.7%

ALL
Hospital committees should not know the identities of the patients and use only medical information to make decisions 3.3%

ALL
Policies like this should be developed with input from patients and community members 4.9%

HCP Only
Individual doctors should make decisions on a case-by-case basis 2.7%

HCP Only
State or federal officials should ensure the law protects hospitals and health care providers who use these policies during a crisis from civil lawsuits (such as malpractice claims)

HCP Only
State or federal officials should ensure the law protects hospitals and health care providers who use these policies during a crisis from criminal penalties (such as criminal negligence claims)

Non-HCP only
State or federal officials should ensure the law protects hospitals and health care providers who use these policies during a crisis from legal repercussions (like malpractice or negligence claims)

6.5%
Section 2: Values surrounding decision making around SRA policy Section Scaling 10-point Likert: I strongly disagree with this (1) to I strongly agree with this (10) or I'd prefer not to answer

Universe Question Prompt Text
Proportion not answered

HCP Header
How strongly do you agree or disagree with the following statements about who should be responsible for making policies to determine who gets life support in a crisis?

HCP Only
There

HCP Header
How strongly do you feel the following health factors should influence how hospitals and health care workers decide who receives a ventilator or other critical care resources during a crisis like a disaster or pandemic?Again, as a reminder, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as ventilators, dialysis machines, ECMO circuits, other supplies, medications, or staff) to care for everyone who needs these resources, and some people will die without these resources. ---

How strongly do you feel the following health factors should influence how hospitals and health care workers decide who receives life support during a crisis like a disaster or pandemic?
Again, as a reminder, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and ---there aren't enough critical care resources (such as life support machines, supplies, medications, or staff) to care for everyone who needs these resources, and some people might die without these resources.

ALL
Patients who are deemed less likely to survive and make it out of the hospital alive 4.3%

HCP Header
How strongly do you agree or disagree about these statements about factors not related to a patient's health should be considered when making decisions about who should receive ventilators or other critical care resources during a crisis like a disaster of pandemic?Again, as a reminder, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as ventilators, dialysis machines, ECMO circuits, other supplies, medications, or staff) to care for everyone who needs these resources, and some people will die without these resources. ---

Non-HCP Header
How strongly do you agree or disagree about these statements about factors not related to a patient's health should be considered when making decisions about who should receive life support during a crisis like a disaster of pandemic?Again, as a reminder, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as life support machines, supplies, medications, or staff) to care for everyone who needs these resources, and some people might die without these resources. ---

ALL
People who are wealthy, famous, or in positions of power (for example: celebrities or politicians) 1.5%

HCP Header
There may be some situations where exceptions are made for certain groups of people under policies like this.How strongly do you agree or disagree that some individuals should be more likely to receive ventilators or other critical care during a crisis because of certain factors not necessarily related to their health?Again, as a reminder, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as ventilators, dialysis machines, ECMO circuits, other supplies, medications, or staff) to care for everyone who needs these resources, and some people will die without these resources. ---

Non-HCP Header
There may be some situations where exceptions are made for certain groups of people under policies like this.How strongly do you agree or disagree that some individuals should be more likely to receive life support or critical care during a crisis because of certain factors not necessarily related to their health?Again, as a reminder, this would be a crisis so catastrophic that providing usual or standard levels of care to all patients is no longer possible, and there aren't enough critical care resources (such as life support machines, supplies, medications, or staff) to care for everyone who needs these resources, and some people might die without these resources. ---

Values surrounding social or non-health factors considered in SRA policy Section Scaling
9-point Likert: Should be much less likely to get life support (1) to Should

not influence one way or the other (5) to Should be much more likely to get life support
(9) or I'd prefer not to answer

strongly disagree to 10, strongly agree) Try to save the most number of lives possible
eFigure 1.Values for SRA Policies Related to Social Factors (Unimputed) eFigure 1: Violin plot of responses to SRA social factor questions by health care worker status.Plots demonstrate distribution of responses.The teal strips represent selfidentified health care workers while the coral strips represent laypersons, with the triangles indicating mean values.eFigure 2. Values for Use of Exemptions in SRA Design eFigure 2: Violin plot of responses to SRA exemption questions by health care worker status.Plots demonstrate distribution of responses.The teal strips represent selfidentified health care workers while the coral strips represent laypersons, with the triangles representing mean values.

should be less likely to 9, should be more likely) Patients who are pregnant in the first trimester
All Respondent) vs. Mean Imputed Respondent and Unimputed California-Only Responses for Agreement Ratings With UC SRA Policy Domains as Drafted