Physician experiences of critical care triage during the COVID-19 pandemic: a scoping review
Notice bibliographique
Résumé
Abstract Background Coronavirus Disease 2019 (COVID-19) overwhelmed health systems globally forcing doctors to make difficult triage decisions where healthcare resources became limited. While there have been several papers surveying the views of the public surrounding triage decisions in various disasters and many academic discussions around the moral distress suffered by physicians because of this, there is little research focussed on collating the experiences of the affected physicians in the critical care setting themselves. Objective The objective of this scoping review is to consolidate the available scientific literature on triage experiences and opinions of doctors (hereby used synonymously with physicians) working in the critical care setting during the COVID-19 pandemic, particularly on issues of moral distress and the role of triage guidelines. In addition, this paper attempts to identify common themes and potential gaps related to this topic. Methods A comprehensive scoping review was undertaken informed by the process outlined by Arksey and O’Malley. Seven electronic databases were searched using keywords and database-specific MeSH terms: CINAHL, Emcare, Medline, PsychINFO, PubMed, Scopus and Web of Science. Google Scholar and references of included articles were subsequently scanned. Included studies had to have an element of data collection surveying physician experiences or opinions on triage with a critical care focus during the COVID-19 pandemic from January 2020 to June 2023. A thematic analysis was subsequently performed to consider physicians’ perspectives on triage and collate any recurrent triage concerns raised during the pandemic. Results Of the 1385 articles screened, 18 were selected for inclusion. Physicians’ perspectives were collected via two methods: interviews (40%) and surveys (60%). Sixteen papers included responses from individual countries, and collectively included: United States of America (USA), Canada, Brazil, Spain, Japan, Australia, United Kingdom (UK), Italy, Switzerland and Germany, with the remaining two papers including responses from multiple countries. Six major themes emerged from our analysis: Intensive Care Unit (ICU) preparedness for triage, role and nature of triage guidelines, psychological burden of triage, responsibility for ICU triage decision-making, conflicts in determining ICU triage criteria and difficulties with end-of-life care. Conclusions While most studies reported critical care physicians feeling confident in their clinical role, almost all expressed anxiety about the impact of their decision-making in the context of an unknown pandemic. There was general support for more transparent guidelines, however physicians differed on their views regarding level of involvement of external ethics bodies on decision-making. More research is needed to adequately investigate whether there is any link between the moral distress felt and triage guidelines. In addition, the use of an age criterion in triaging criteria and the aetiology of moral distress requires clearer consensus from physicians through further research which may help inform the legislative reform process in effectively preparing for future pandemics.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».