How does the prioritisation of care affect ICU healthcare professionals?

Healthsystem crises, for instance caused by wars, terrorist attacks, environmental disasters, or pandemics, may cause a considerable scarcity of resources, resulting in the need to prioritize care. This study aimed to assess how prioritisation processes have affected health care professionals (HCPs) in intensive care units in (ICUs) in Spain and Germany and how it will likely affect them in future scarcity scenarios.

A multicentre, observational, cross-sectional study design was used. Data were collected in ICUs across two Spanish and three German regions between November and December 2024. The questionnaire comprised 53 items and included work-related and sociodemographic characteristics, the Ethical Decision-Making Climate Questionnaire (EDMCQ) and items related to job strain, professional responsibility regarding healthcare costs, and the need to prioritize care in situations of resource scarcity.

Two hundred and fifteen ICU HCPs participated in the study, 80 from Germany and 135 from Spain. German HCPs reported a more favourable perception of the ethical climate than their Spanish counterparts (p 〈0,001). A more positively perceived ethical climate correlated significantly with a lesser intention to leave one's job. Also, agreeing that clinicians should take prioritisation decisions caused lesser job strain than disagreeing (p < 0,05).

Differences in the perception of the ethical climate may be partly attributable to variations in end-of-life practices. The ethical climate contributes significantly to the intention to leave one's job. Exposure to prioritisation processes during scarcity scenarios may likely result in moral distress, and rigid utilitarian prioritisation strategies may be perceived as burdensome to HCPs.