Waiting for radiotherapy a national call for ethical discourse on waiting lists in radiotherapy: findings from a preliminary survey.
OBJECTIVE
Growing incidence of cancer and the demographic changes of the society can cause severe shortage in radiotherapy services. This can lead to the use of waiting lists, which can serve as an indicator model for shortage of medical service. To investigate whether and how waiting lists are used in Germany, a survey was undertaken among German radio-oncologists. Their opinion concerning the use of waiting lists and their attitude toward the involved ethical problems were the central topics of this study.


METHODS
A questionnaire was developed which consisted of 18 items: four items covered general aspects, four were about the management of waiting lists, seven concerned problems of waiting lists, and three were about the future aspects. From all items, at least ten touched ethical aspects such as patient information or the doctor-patient relationship. 19 consecutive radio-oncologists answered the questionnaire via telephone. The main interest of this study was to generate further hypotheses for future research.


RESULTS
From all doctors (n = 19), most did not use waiting lists (n = 12) in their practice, whereas the remaining did use them (n = 7). Limited resources were seen as the central underlying problem (n = 16). Two guiding principles were most often quoted for managing waiting lists: patients with complaints such as pain before those without (n = 18) and curative before palliative radiotherapy (n = 15). Concerning the information given to patients about the use of waiting lists, some doctors voted for detailed information (n = 7), which covers negative side effects of waiting lists such as tumor progression during waiting time, others voted against (n = 11). There was a profound disagreement on the question of whether curative and palliative radiotherapy should be differently treated in the context of waiting lists. 70% of the group, who used waiting lists, could give a moral justification for waiting lists, whereas only 28% of the group, who did not use them, could offer a justification.


CONCLUSIONS
The survey showed that doctors were most concerned about the ethical aspects of waiting lists. Open questions are: (1) What is the best principle for a fair distribution of limited radiotherapy places? (2) How should patients be informed about waiting lists? (3) What moral justifications can be given for waiting lists? These issues must therefore become topics of future research and national dialogue, because the answers to these questions are necessary for the clinical use of waiting lists in radiotherapy.
Schäfer
Christof
C
Department of Radiotherapy, University Hospital, Regensburg, Germany. christof.schaefer@klinik.uni-regensburg.de
Nelson
Kristin
K
Herbst
Manfred
M
D003625:Data Collection; D003627:Data Interpretation, Statistical; D005544:Forecasting; D005858:Germany; D006801:Humans; D009014:Morals; D010166:Palliative Care; D010817:Physician-Patient Relations; D018787:Radiation Oncology; D011878:Radiotherapy / Q000941:ethics / Q000639:trends; D012106:Research; D040841:Resource Allocation; D012935:Social Justice; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists