Clinical Priority Setting and Decision-Making in Sweden: A Cross-sectional Survey Among Physicians

Background  Priority setting in healthcare that aims to achieve a fair and efficient allocation of limited resources is a worldwide challenge. Sweden has developed a sophisticated approach. Still, there is a need for a more detailed insight on how measures permeate clinical life. This study aimed to assess physicians’ views regarding (۱) impact of scarce resources on patient care, (۲) clinical decision-making, and (۳) the ethical platform and national guidelines for healthcare by the National Board of Health and Welfare (NBHW). Methods  An online cross-sectional questionnaire was sent to two groups in Sweden, ۲۰۱۶ and ۲۰۱۷. Group ۱ represented ۳۳۱ physicians from different departments at one University hospital and group ۲ consisted of ۹۲۳ members of the Society of Cardiology. Results  Overall, a ۲۶% (۳۲۸/۱۲۵۴) response rate was achieved, ۴۹% in group ۱ (۱۶۲/۳۳۱), ۱۸% in group ۲ (۱۶۶/۹۲۳). Scarcity of resources was perceived by ۵۹% more often than ‘at least once per month,’ whilst ۶۰% felt less than ‘wellprepared’ to address this issue. Guidelines in general had a lot of influence and ۱۹% perceived them as limiting decisionmaking. ۸۶% professed to be mostly independent in decision-making. ۳۶% knew the ethical platform ‘well’ and ‘very well’ and ۶۴% NBHW’s national guidelines. ۵۷% expressed a wish for further knowledge and training regarding the ethical platform and ۵۱% for support in applying NBHW’s national guidelines. Conclusion  There was a need for more support to deal with scarcity of resources and for increased knowledge about the ethical platform and NBHW’s national guidelines. Independence in clinical decision-making was perceived as high and guidelines in general as important. Priority setting as one potential pathway to fair and transparent decision-making should be highlighted more in Swedish clinical settings, with special emphasis on the ethical platform.

کلیدواژه ها:

Priority Setting ، Sweden ، National Guidelines ، ، Physician ، Fair Allocation ، Decision-Making