Medical Triage in a Time of Scarce Resources. (XPHI-COVID-2)
Medical Triage in a Time of Scarce Resources: a Randomized Controlled Study.
The XPHI-COVID-2 randomized study aims to investigate the moral choices in a context of scarce resources.
The participants are asked to complete the questionnaire of the Oxford Utilitarianism Scale and are exposed to medical triage dilemmas.
Participants are randomized between a group with reading of ethical guidelines and a group without reading of ethical guidelines, before they are asked to complete the questionnaire and being exposed to triage dilemmas.
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
It is hypothesized that recalling ethical values before resolving dilemmas could modify the ability to adopt a utilitarian approach in resolving ethical dilemmas.
To verify this hypothesis, the score on the Impartial Harm subscale of the Oxford Utilitarianism Scale (IH-OUS) will be compared between a group with reading of ethical guidelines and a group without reading of ethical guidelines, before they are asked to complete the questionnaire and being exposed to triage dilemmas.
Number of subjects needed for the phase of study evaluating intensivists, anesthesiologists and emergency physicians : 580 - based on preliminary data, assuming 70% complete response rate of the survey and a standard deviation of 5
Secondary outcomes will be considered :
- Beneficence Harm subscale of the Oxford Utilitarianism Scale (IB-OUS)
- Values prioritized to resolve ethical dilemmas : impartial of benefits, prioritization of the young age, saving life years, saving most lives, equality of treatment, prioritization of the worst off, loyalty duty, principle of non-discrimination, prospective and retrospective instrumental value.
First phase of the study will aim to include first-line caregivers : intensivists, anesthesiologists, emergency physicians.
Other phases of the study will aim to include health care professionals from other categories and non health care professionals.
Subgroup analyses are planned :
- Analysis according to the characteristics of the participant: gender, geographic location, diploma and type of exercise, category of institution to which the participant is attached.
- Analysis according to the degree of knowledge in ethics, the degree of familiarity with ethical recommendations, the degree of familiarity with moral philosophy, the degree of religiosity, whether the participants declare to have taken knowledge or not of recommendations concerning medical triage in a situation of scarce resources.
It is also planned to carry out ancillary studies in parallel with the realization of the study presented here:
- A study including non-physician participants aiming to identify the differences between non-physicians and physicians in terms of ethical values mobilized in medical triage.
- A study including medical students aiming to identify an association between propensity to make utilitarian and choices of the medical specialty.
- A study focused on the Oxford Utilitarianism Scale, integrating the results of the pilot study and the confirmatory study, aiming to identify predictors of responses to the dilemmas proposed within the scale.
- A study evaluating the association between delay in ethical dilemmas resolution and utilitarian choices.
Undersøgelsestype
Tilmelding (Forventet)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
- Navn: Clément GAKUBA, MD PhD
- Telefonnummer: +33231064736
- E-mail: gakuba-c@chu-caen.fr
Undersøgelse Kontakt Backup
- Navn: Florian COVA, PhD
- E-mail: Florian.Cova@unige.ch
Studiesteder
-
-
Calvados
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Caen, Calvados, Frankrig, 14000
- Rekruttering
- Caen University hospital
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Kontakt:
- Clément GAKUBA, MD
- Telefonnummer: +33231064736
- E-mail: gakuba-c@chu-caen.fr
-
-
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Caregivers
- Noncaregivers from general population
Exclusion Criteria:
- Withdrawal of agreement
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Andet
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Tredobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
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Eksperimentel: Intervention
The participants have to read ethical guidelines before they are asked to complete the questionnaire of the Oxford Utilitarianism Scale and exposed to medical triage dilemmas.
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Reading of ethical guidelines.
|
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Ingen indgriben: No intervention
The participants do not have to read ethical guidelines before they are asked to complete the questionnaire of the Oxford Utilitarianism Scale and exposed to medical triage dilemmas.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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IH-OUS score
Tidsramme: At the end of the inclusion period
|
Score on the Impartial Harm subscale of the Oxford Utilitarianism Scale (IH-OUS) : minimum value is 4 points and maximum value is 28 points. The higher the value is, the more the participant's choices endorse the principle of causing harm to bring the greater good. |
At the end of the inclusion period
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Utilitarian score
Tidsramme: At the end of the inclusion period
|
One point is given for each choice consistent with utilitarian principles when solving triage dilemmas, scaling this score from 0 to 14.
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At the end of the inclusion period
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IB-OUS score
Tidsramme: At the end of the inclusion period
|
Score on the Instrumental Beneficence subscale of the Oxford Utilitarianism Scale (IB-OUS) : minimum value is 5 points and maximum value is 35 points. The higher the value is, the more the participant's choices endorse the impartial maximization of the greater good, even at the cost of personal self-sacrifice. |
At the end of the inclusion period
|
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Oxford utilitarianism scale
Tidsramme: At the end of the inclusion period
|
Bi-dimensional scale of utilitarian thinking associating the impartial harm and the beneficence subscale. The minimum value is 9 points and the maximum value is 63 points. This scale aims to assess the utilitarian tendencies in people who are not philosophy professionals. |
At the end of the inclusion period
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Impartial of benefits
Tidsramme: At the end of the inclusion period
|
Principle of impartial assignment of resources used in resolving ethical dilemmas. The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value. |
At the end of the inclusion period
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Prioritization of the young age
Tidsramme: At the end of the inclusion period
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Propensity to prioritize the youngest person in ethical dilemmas.
The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value.
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At the end of the inclusion period
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Saving life years
Tidsramme: At the end of the inclusion period
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Propensity to save the most life years in resolving ethical dilemmas.
The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value.
|
At the end of the inclusion period
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Saving most lives
Tidsramme: At the end of the inclusion period
|
Propensity to save most lives in resolving ethical dilemmas.
The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value.
|
At the end of the inclusion period
|
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Equality of treatment
Tidsramme: At the end of the inclusion period
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Propensity to treat people equally in ethical dilemmas.
The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value.
|
At the end of the inclusion period
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Prioritization of the worst off
Tidsramme: At the end of the inclusion period
|
Propensity to prioritize the worst off in ethical dilemmas.
The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value.
|
At the end of the inclusion period
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Duty of loyalty
Tidsramme: At the end of the inclusion period
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Propensity of the caregiver to feel obliged vis-a-vis the patient The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value.
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At the end of the inclusion period
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Principle of non-discrimination (based on age, disability, socio-economic characteristics, gender, etc.)
Tidsramme: At the end of the inclusion period
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The non-discrimination principle requires the equal treatment of an individual or group irrespective of their particular characteristics. The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value. |
At the end of the inclusion period
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Prospective instrumental value
Tidsramme: At the end of the inclusion period
|
Propensity to promote and reward prospective instrumental value, based on future facts. The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value. |
At the end of the inclusion period
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Retrospective instrumental value
Tidsramme: At the end of the inclusion period
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Propensity to promote and reward retrospective instrumental value, based on past facts. The value will be considered as respected by the majority of participants if more than 50% of respondents make a choice of a patient in accordance with this value. |
At the end of the inclusion period
|
Samarbejdspartnere og efterforskere
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Clément GAKUBA, MD PhD, University Hospital, Caen
Publikationer og nyttige links
Generelle publikationer
- Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020 May 21;382(21):2049-2055. doi: 10.1056/NEJMsb2005114. Epub 2020 Mar 23. No abstract available.
- Kahane G, Everett JAC, Earp BD, Caviola L, Faber NS, Crockett MJ, Savulescu J. Beyond sacrificial harm: A two-dimensional model of utilitarian psychology. Psychol Rev. 2018 Mar;125(2):131-164. doi: 10.1037/rev0000093. Epub 2017 Dec 21. Erratum In: Psychol Rev. 2018 Mar;125(2):164.
- Capraro, V., Earp, B.D., & Everett, J.A.C. (2019). Priming intuition disfavors instrumental harm but not impartial beneficence. Journal of Experimental Social Psychology. 83, 142-149. DOI: 10.1016/j.jesp.2019.04.006.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Forventet)
Studieafslutning (Forventet)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
- 1475 (CSL Behring)
Plan for individuelle deltagerdata (IPD)
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