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206:oral But sometimes you end up giving in and giving them what they’re not entitled to, because it’s too difficult to say no.’– A qualitative study among physicians and nurses on clinical priority-setting in oncology
  1. Ingrid Miljeteig1,
  2. Helge Alsaker Solheim2
  1. 1University of Bergen and Haukeland University Hospital
  2. 2Dept. of Research and Development; Haukeland University Hospital; Norway

Abstract

Background Even in a generously funded health care system as the Norwegian, there are limits for what can be provided. Our objectives are to explore in which situations physicians and nurses find it hard to refuse the patients’ requests or demand for treatment and care that is not prioritized or they are not entitled to, what kind of strategies they use in order to change the patients´ mind and how they justify their actions.

Methods Focus group interviews with interdisciplinary teams at Department of Oncology and Medical Physics and Department of Thoracic Medicine at Haukeland University Hospital, Norway. Findings were analyzed using systematic text condensation.

Results All the 63 participants had experienced patients asking for treatment, hospitalization or care which were not prioritized or the participants found to be less important to provide. While the nurses negotiated on issues like single room, longer hospital stay, earlier appointments or paid transportation, physicians reporting more disagreement when it came to the level of treatment. The physicians found it most difficult to refuse patients’ request for promising new treatment available in other countries, but not prioritized by the Norwegian government. Strategies used to help patients accept their decisions included referring to policy and principles, introduce someone with more authority, focus on side effects and appeal to solidarity. Many lacked good, ethical acceptable strategies. All providers had experiences of giving in, and their justifications were lack of time to argue with the patients, that it was uncomfortable and to keep a good relationship with the patient.

Discussion How bedside priorities are done, and what strategies nurses and physicians are using when negotiating in these situations should get more attention and the providers should be trained to handle these challenges. Clear guidelines, leadership and meeting arenas to discuss and reflect with colleagues are important.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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