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Citation
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Daugherty Biddison EL, Gwon H, Schoch-Spana M, Cavalier R, White DB, Dawson T, Terry PB, London AJ, Regenberg A, Faden RR, Toner ES. Ann. Am. Thorac. Soc. 2014; 11(5): 777-783. |
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Affiliation
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Johns Hopkins School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States ; edaughe2@jhmi.edu. |
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Abstract
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INTRODUCTION: Pandemic influenza or other crises causing mass respiratory failure could easily overwhelm current North American critical care capacity. This threat has generated large-scale federal, state, and local efforts to prepare for a public health disaster. Few, however, have systematically engaged the public regarding what values are most important in guiding decisions about how to allocate scarce healthcare resources during such crises.
METHODS: The aims of this pilot study were to (1) test whether deliberative democratic methods could be used to promote engaged discussion about complex, ethically challenging healthcare related policy issues, and (2) develop specific deliberative democratic procedures that could ultimately be used in a state-wide process to inform a Maryland framework for allocating scarce healthcare resources during disasters. Using collaboratively developed focus group materials and multiple metrics for assessing outcomes, we held 5-hour pilot community meetings in two locations in Maryland with a total of 68 community members. The key outcomes used to assess the project were, (1) comprehensibility of the background materials and ethical principles, (2) salience of the ethical principles, (3) perceived usefulness of the discussions, (4) the degree to which participants' opinions evolved due the discussions, and (5) the quality of participant engagement.
RESULTS: Most participants were thoughtful, reflective, and invested in this pilot policy-informing process. Through the pilot process, changes were made to background materials, the verbal introduction, and pre- and post-surveys. Importantly, by holding pilot meetings in 2 distinct communities - an affluent suburb and inner city neighborhood - investigators discerned that participant's ethical reflections were framed in large part by their place-based life experiences.
CONCLUSION: This finding, coupled with extensive feedback from participants, yielded a refined methodology suitable for wider-scale use and underscored the need for involvement of diverse communities in a state-wide engagement process on this critical policy issue.
Language: en |