Are patients receiving enough information about healthcare rationing? A qualitative study.
BACKGROUND
There is broad international agreement from clinicians and academics that healthcare rationing should be undertaken as explicitly as possible, and the BMA have publicly supported the call for more accountable priority setting for some time. However, studies in the UK and elsewhere suggest that clinicians experience a number of barriers to rationing openly, and the information needs of patients at the point of provision are largely unknown.


METHODS
In-depth interviews were undertaken with NHS professionals working at the community level of provision, and with patients and professionals receiving or providing treatment for morbid obesity and breast cancer (n=52).


RESULTS
Nearly all patients wanted to know about healthcare rationing and had high expectations of their clinical professionals to provide all relevant information about treatment options. However, professionals did not always understand these information requirements, and cases of implicit rationing were common. The existence of relevant national guidance was not always known about, meaning that patients were often reliant on other sources of information about treatment options, which included the popular media, the internet, patient advocacy groups and informal networks of support.


CONCLUSIONS
Clinical professionals need to understand patients' need for detailed information when it comes to rationing, and to understand that they are the main gateway for this to be provided. However, disclosure could be distressing for both patients and professionals, and thus the most sensitive and acceptable ways to make this information available requires further investigation.
Department of Social Medicine, Canynge Hall, University of Bristol, Bristol BS8 2PS, UK. a.owen-smith@bris.ac.uk
Amanda
A
Owen-Smith
Joanna
J
Coast
Jenny
J
Donovan
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics; D003659:Decision Making, Organizational; D005260:Female; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics; D010353:Patient Education as Topic; D010817:Physician-Patient Relations / Q000941:ethics; D036301:Qualitative Research; D011787:Quality of Health Care / Q000191:economics / Q000941:ethics / Q000458:organization & administration; D055815:Young Adult