Lack of support structures in prioritization decision making concerning patients and resources. Interviews with Swedish physicians

Abstract

Aim: To investigate physicians’ experiences in relation to prioritization and financing in health care in order to gain a deeper understanding of the reasons behind their standpoints. Methods: Eighteen physicians, seven women and eleven men, aged 30 to 69 years were interviewed and the text was analyzed using an inductive approach, also described as conventional qualitative content analysis. Results: Experience of setting healthcare priorities and difficult decision making differed widely among the physicians and seemed to be related to the number of years in professional practice. Their view of how resources should be allocated between disciplines/patients showed that they wanted politicians to make the decisions, with support from medical professions. The overwhelming impression of their reasoning showed that they lacked support structures for their decision making and could be understood under the following categories: Prioritisation, easier in theory than in practice, and Increasing costs threaten the Swedish welfare model. Conclusions: The findings of this study highlight the importance of practical national guidelines concerning vertical prioritization, also as an important measure to make prioritization more distinct and transparent. The physicians further had a need for tools to increase patients’ awareness of their health. The findings of this study also showed that an awareness of the actual costs involved might increase the responsibility among both physicians and patients. The physicians’ lack of support structures implies an urgent need for practical national guidelines, especially concerning vertical prioritization. This will also make prioritization appear clear and transparent for citizens.

Clinical Priority Setting and Decision-Making in Sweden: A Cross-sectional Survey Among Physicians

“…18 Further studies have reported that physicians expressed a lack of support structures 19 and a lack of basic training and support of ethical principles. 15 There was a need for more open dialogues and discussions about priority setting, more practical and clearer national guidelines, 15,19 as well as more evidence for the treatment of elderly multimorbid patients. 20 Although Sweden has developed a sophisticated approach to priority setting in healthcare, there is thus still a need for a more detailed insight on how it permeates the micro level of decision-making.…”

“…17 In 2015, it was reported that 76% of the heads of different hospital departments applied the NBHW’s national guidelines, 33% in their original form, 69% through local guidelines. 18 Further studies have reported that physicians expressed a lack of support structures 19 and a lack of basic training and support of ethical principles. 15 There was a need for more open dialogues and discussions about priority setting, more practical and clearer national guidelines, 15 , 19 as well as more evidence for the treatment of elderly multimorbid patients.…”

“…18 Further studies have reported that physicians expressed a lack of support structures 19 and a lack of basic training and support of ethical principles. 15 There was a need for more open dialogues and discussions about priority setting, more practical and clearer national guidelines, 15 , 19 as well as more evidence for the treatment of elderly multimorbid patients. 20…”