Attitudes of health professionals concerning bedside rationing criteria: a survey from Portugal

Abstract

This paper tests the factorial structure of a questionnaire comprising seven health care rationing criteria (waiting time, ‘rule of rescue’, parenthood of minors, health maximization, youngest first, positive and negative version of social merit) and explores the adherence to them of 254 Portuguese health care professionals, when considered individually and when confronted with two-in-two combinations. Data were collected through a self-administered questionnaire where respondents faced hypothetical rationing dilemmas comprising one rationing criterion and dichotomous options pairs with two rationing criteria. Confirmatory factor analysis and multinomial logistic regressions were used to validate the structure of the questionnaire and the data. The findings suggest that: (i) the hepta-factorial structure of the questionnaire presented a good fit of the data; and (ii) support for rationing criterion depends on whether they are individually considered or confronted in dichotomous options pairs. When only one criterion distinguishes the patients, healthcare professionals support six criteria (by descending order): waiting time, rule of rescue, health maximization, penalization of patients’ risky behaviors, youngest first and being parent of a young child. When two criteria were confronted, immediate threat of life/health and large expected benefits were the most preferred. Conversely, the positive version of social merit was an unappreciated rationing criterion.

The challenge posed by the COVID-19 pandemic: how to decide who deserves life-saving medical devices?

“…Just as the general population has a duty to comply with measures to contain the spread of the disease, it also has the right to participate in the definition of the criteria that will dictate which friends and family members live or die. There is a growing empirical literature on the views of healthcare professionals (Pinho and Veiga, 2020) and the general public (Pinho and Borges, 2015;Pinho, 2016) concerning the criteria that should support healthcare rationing decisions in Portugal. The results seem to indicate that both stakeholder groups support multiple criteria or ethical values.…”

Hospital staff members' preferences about who should be prioritized to receive the COVID-19 vaccine: People with or without Alzheimer's disease?

“…However, the abovementioned studies were conducted among samples in the general public. In the current study – which focused on the intentions of professionals not for themselves but for their patients – professionals selected those individuals who they perceived to be more likely to benefit from the vaccine, as has been demonstrated in priority-setting studies in other areas ( Pinho & Veiga, 2020 ).…”

A decision support system to solve the problem of health care priority-setting

“…Therefore, based on these health professionals' respondents' answers the criteria weighting was defined through AHP. Thus, the data from Pinho and Veiga (2020) were used to reach the second step of the present study, namely, the calculation of the criteria weight through the AHP method.…”

“…The results suggest that stakeholders support not one but a multiplicity of rationing criteria. The range of criteria for setting explicit priorities can be divided into the following three groups (Pinho and Veiga, 2020; for a review):…”