Patients' views on priority setting in neurosurgery: A qualitative study.
OBJECTIVE
Accountability for Reasonableness is an ethical framework which has been implemented in various health care systems to improve and evaluate the fairness of priority setting. This framework is grounded on four mandatory conditions: relevance, publicity, appeals, and enforcement. There have been few studies which have evaluated the patient stakeholders' acceptance of this framework; certainly no studies have been done on patients' views on the prioritization system for allocating patients for operating time in a system with pressure on the resource of inpatient beds. The aim of this study is to examine neurosurgical patients' views on the prioritization of patients for operating theater (OT) time on a daily basis at a tertiary and quaternary referral neurosurgery center.


METHODS
Semi-structured face-to-face interviews were conducted with thirty-seven patients, recruited from the neurosurgery clinic at Toronto Western Hospital. Family members and friends who accompanied the patient to their clinic visit were encouraged to contribute to the discussion. Interviews were audio recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding.


RESULTS
Overall, patients are supportive of the concept of a priority-setting system based on fairness, but felt that a few changes would help to improve the fairness of the current system. These changes include lowering the level of priority given to volume-funded cases and providing scheduled surgeries that were previously canceled a higher level of prioritization. Good communication, early notification, and rescheduling canceled surgeries as soon as possible were important factors that directly reflected the patients' confidence level in their doctor, the hospital, and the health care system.


CONCLUSIONS
This study is the first clinical qualitative study of patients' perspective on a prioritization system used for allocating neurosurgical patients for OT time on a daily basis in a socialized not-for-profit health care system with fixed resources.
a Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto , Toronto , Canada.
Caroline
C
Gunaratnam
a Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto , Toronto , Canada.
Mark
M
Bernstein
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making / Q000502:physiology*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D036301:Qualitative Research; D012017:Referral and Consultation; D012941:Social Responsibility; D011795:Surveys and Questionnaires; D055815:Young Adult
brain tumors; neurosurgery; operative experience; theater time utilization