The Role of Physicians in Rationing Cancer Care. Attitudes of German Oncologists

Abstract

Background: Against the background of limited resources, the rise in the cost of therapy as well as in the number of cancer patients fuels the discussion about the necessity to ration, i.e., setting limits to beneficial treatment for cost reasons. Recently, we presented the self-reported prevalence of bedside rationing among German oncologists. Here, we describe oncologists' views on cost containment strategies and their role therein. Methods: We performed an online survey including structured questions and free field sections with the members of the German Society of Hematology and Oncology. Results: In the perception of oncologists, cost considerations and negotiations are gaining in importance and consume considerable working time. This negatively affects job satisfaction in 72% of the 345 respondents. Oncologists are concerned that the quality of care will suffer from rationalization and implicit rationing. They are ambivalent as to who is best suited to decide about resource rationing: 66% support the view that limits for costly procedures should be set by a form of commission; nevertheless, 48% consider physicians as the best decision makers in these situations. Conclusion: We suggest a broad public discussion and an interdisciplinary debate among the oncology community to define and legitimize decisions on rationing by setting explicit criteria.

Rationing cancer treatment: a qualitative study of perceptions of legitimate limit-setting

“…As far as we are aware, this is the first qualitative study of oncologists’ views on the legitimacy of restrictions on access to new and expensive cancer drugs in a setting where national criteria-based priority setting is implemented and where a centralised drug review system is in place (but see [ 22 ]). This section considers key findings from the study.…”

“…The impact on doctor-patient relationship was a concern. Previous studies have concluded that limited drug funding and access has significant negative impact on oncologists’ practice [ 17 , 18 , 22 ]. Also, some of the participants experienced an unresolved ethical issue about whether to inform patients about drugs they did not think the patient would be able to pay for.…”

“…To our knowledge, there are hardly any qualitative study of oncologists’ perceptions of the legitimacy of restricting access to new and expensive cancer drugs available. A recent study of the role of oncologists in rationing cancer care in Germany (using quantitative and qualitative data), found that job satisfaction was negatively affected by cost considerations and negotiations in 72% of the respondents [ 22 ]. Further, the respondents were concerned about the quality of care as a result of implicit rationing, and the authors highlighted the need for the development of explicit criteria which are ethically and legally more justifiable.…”

Sekundärnutzung klinischer Daten in datensammelnden, nicht-interventionellen Forschungs- oder Lernaktivitäten – Begriff, Studientypen und ethische Herausforderungen

“…Neben Auch ist zu befürchten, dass sich ein Vergleich von Stationen oder Kliniken nicht nur auf die Qualität der Versorgung, sondern auch und primär auf Wirtschaftlichkeit (Profitabilität und Kosten) fokussieren und in dieser Sphäre einen Konkurrenzdruck um die "günstigste oder profitabelste Behandlung" weiter befeuern könnte. In einem Gesundheitssystem, welches ohnehin bereits unter hohem Kosten-und Ökonomisierungsdruck leidet (Strech et al 2008;Fernau et al 2017;Krause et al 2013), könnte dies einen weiteren Faktor zur Zuspitzung der Lage darstellen und durchaus negative Auswirkungen auf die Versorgungssituation selbst haben. Allerdings ist auch zu bemerken, dass ein Blick auf die Kosten von Behandlung im Rahmen eines eingepflegten Wirtschaftlichkeitsgebots stets erforderlich ist und z.…”

Value and Values in Cancer Care. Assessing the Benefit of Treatment in Patients with Advanced Cancer

“…Only 29% reported being explicit about their rationing decision, if the patient did not know or inquire about the respective intervention. Further analysis of data of the same study including qualitative content analysis of free text answers shows that according to the perception of participating oncologists [20], cost considerations and negotiations in Germany are gaining in importance and consume considerable working time. Respondents not only reported negative effects of dealing with these issues on the job (72%), but also were concerned that the quality of care will be compromised by cost pressure.…”