The effect of priority setting decisions for new cancer drugs on medical oncologists' practice in Ontario: a qualitative study.
BACKGROUND
Health care policies, including drug-funding policies, influence physician practice. Funding policies are especially important in the area of cancer care since cancer is a leading cause of death that is responsible for a significant level of health care expenditures. Recognizing the rising cost of cancer therapies, Cancer Care Ontario (CCO) established a funding process to provide access to new, effective agents through a "New Drug Funding Program" (NDFP). The purpose of this study is to describe oncologists' perceptions of the impact of NDFP priority setting decisions on their practice.


METHODS
This is a qualitative study involving semi-structured, in-depth interviews with 46 medical oncologists in Ontario. Oncologists were asked to describe the impact of CCO's NDFP drug funding decisions on their practice. Analysis of interview transcripts commenced with data collection.


RESULTS
Our key finding is that many of the medical oncologists who participated in this study did not accept limits when policy decisions limit access to cancer drugs they feel would benefit their patients. Moreover, overcoming those limits had a significant impact on oncologists' practice in terms of how they spend their time and energy and their relationship with patients.


CONCLUSIONS
When priority setting decisions limit access to cancer medications, many oncologists' efforts to overcome those limits have a significant impact on their practice. Policy makers need to seriously consider the implications of their decisions on physicians, who may go to considerable effort to circumvent their policies in the name of patient advocacy.
Division of Medical Oncology/Hematology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Canada. scott.berry@sunnybrook.ca
Scott R
SR
Berry
Stacey
S
Hubay
Hagit
H
Soibelman
Douglas K
DK
Martin
D000970:Antineoplastic Agents / Q000191:economics* / Q000600:supply & distribution; D001291:Attitude of Health Personnel; D003657:Decision Making; D017277:Drug Approval / Q000191:economics / Q000331:legislation & jurisprudence; D005260:Female; D006291:Health Policy; D006292:Health Priorities / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology / Q000191:economics / Q000639:trends*; D009369:Neoplasms / Q000188:drug therapy*; D009864:Ontario; D010344:Patient Advocacy; D010817:Physician-Patient Relations; D011216:Practice Management, Medical; D017009:Professional Autonomy; D036301:Qualitative Research
D000970:Antineoplastic Agents