Laypersons' Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer's Disease Matter?

Understanding stigma of dementia during COVID-19: a scoping review

Introduction

Stigma of dementia is one of the greatest challenges for people living with dementia. However, there is little research on the different types of stigma of dementia in the COVID-19 pandemic. The purpose of this scoping review is to synthesize the existing literature on dementia-related stigma (self, public, and structural stigma), during the pandemic.

Methods

Guided by Arksey and O'Malley's scoping review framework and PRISMA guidelines, CINAHL, EMBASE, Google Scholar, Medline, PsycINFO, and Web of Science were searched for English language literature from January 2020 to June 2023. Inclusion criteria consisted of peer-reviewed, original research articles addressing stigma of dementia during the COVID-19 pandemic. Thematic analysis was used to analyze the data and steps were taken to ensure rigor.

Results

Fifteen articles met our inclusion criteria. Four primary themes were identified including: 1) COVID-19 stereotypes and assumptions of dementia; 2) human rights issues and deprived dignity; 3) disparate access to health services and supports; and 4) cultural inequities and distrust.

Discussion

The COVID-19 pandemic has contributed to the stigmatization of people living with dementia. Further research is needed to develop, implement, and evaluate interventions targeted towards the different types of dementia-related stigma (including self, public, and structural stigma). Moreover, our findings highlight the need for more collaborative research that prioritizes the lived experience and input of diverse people living with dementia. Research partnerships with diverse people living with dementia are vital to improving future pandemic planning. Only through evidence-informed research and lived experience can we begin to fully address the different types of dementia-related stigma and enhance the quality of life of people living with dementia.

Explicit discrimination and ingroup favoritism, but no implicit biases in hypothetical triage decisions during COVID-19

Disturbingly realistic triage scenarios during the COVID-19 pandemic provide an opportunity for studying discrimination in moral reasoning. Biases and favoritism do not need to be explicit and overt, but can remain implicit and covert. In addition to assessing laypeople's propensity for engaging in overt discrimination, the present study examines whether they reveal implicit biases through seemingly fair random allocations. We present a cross-sectional online study comprising 6 timepoints and a total of 2296 participants. Each individual evaluated 19 hypothetical scenarios that provide an allocation dilemma between two patients who are in need of ventilation and differ only in one focal feature. Participants could either allocate the last ventilator to a patient, or opt for random allocation to express impartiality. Overall, participants exhibited clear biases for the patient who was expected to be favored based on health factors, previous ethical or caretaking behaviors, and in-group favoritism. If one patient had been pre-allocated care, a higher probability of keeping the ventilator for the favored patient indicates persistent favoritism. Surprisingly, the absence of an asymmetry in random allocations indicates the absence of covert discrimination. Our results demonstrate that laypeople's hypothetical triage decisions discriminate overtly and show explicit biases.

Community preferences for the allocation of scarce healthcare resources during the COVID-19 pandemic: a review of the literature

OBJECTIVE

The purpose of this thematic review is to examine the literature on the publics' preferences of scarce medical resource allocation during COVID-19.

STUDY DESIGN

Literature review.

METHODS

A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles.

RESULTS

Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members.

CONCLUSION

The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.

Hospital staff members' preferences about who should be prioritized to receive the COVID-19 vaccine: People with or without Alzheimer's disease?

Background

There is no doubt that people with dementia can greatly benefit from the COVID-19 vaccine, especially as they are at an increased risk of developing severe complications, including long hospitalizations and high mortality rates, as a result of being infected by the virus. However, they might need the encouragement of health professionals to become vaccinated. Professionals' preferences regarding vaccination for this group are, therefore, extremely important to increase the use of this preventive measure.

Aims

1. To examine hospital staff members' preferences for COVID-19 vaccination to people with or without Alzheimer's disease (AD) while differentiating between a young and an old person with the disease. 2. To examine the factors associated with these preferences.

Methods

A cross-sectional survey using a structured and anonymous self-report questionnaire was conducted among a sample of 278 Israeli medical staff (nurses, physicians, and paraprofessionals) working at a general hospital. The data were collected in August 2021.

Results

Overall, the majority (68.4%) of participants chose the 80-year-old patient with a diagnosis of AD to be the last to receive the vaccine. The percentage of participants who preferred to give the vaccine first to the 55-year-old patient with AD was almost equal to the percentage of those who preferred giving the vaccine first to the 80-year-old patient who was cognitively intact. Religion and beliefs about susceptibility to contracting COVID-19 were significantly associated with participants' preferences.

Conclusion

Our results suggest that hospital staff members find it difficult to decide whether age or cognitive status should be the main factor in deciding which patient should receive the vaccine first. Therefore, there is a need to implement several policy and practical steps in hospitals to assist the medical staff in such decision-making processes.