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Am J Hosp Palliat Care. 2019 Feb 25:1049909119833333. doi: 10.1177/1049909119833333. [Epub ahead of print]

The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study.

Author information

1
1 St Vincent's Hospital and Victorian Comprehensive Cancer Centre, University of Melbourne, Victoria, Australia.
2
2 St Vincent's Hospital, University of Melbourne, Victoria, Australia.
3
3 Department of Medicine, University of Melbourne, Victoria, Australia.
4
4 Department of Preventive Medicine, Monash University, Victoria, Australia.
5
5 Department of Palliative Care, Royal Melbourne Hospital, Victoria, Australia.
6
6 Pain and Palliative Care Service, Peter McCallum Cancer Centre, Victoria, Australia.
7
7 Vrije University, Brussels, Belgium.
8
8 LaTrobe University, Victoria, Australia.

Abstract

OBJECTIVE::

This article sought to explore ethical issues associated with prioritization decisions in palliative care.

METHODS::

As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis.

SETTING/PARTICIPANTS::

Twenty health professionals working across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia.

RESULTS::

Four themes emerged from the data: (1) Clinicians understood the tension between maintaining service quality with the delivery of a compromised service that sought to respond to demand. (2) They were aware of the influences of relationships and responsibilities upon patient waiting list prioritization, and (3) reported a hierarchy of suffering with certain types of clinical problems viewed as more urgent than others, for example, pain being more urgent than existential distress. (4) Clinicians noted a lack of transparency around waiting lists as they currently exist.

CONCLUSIONS::

This study revealed key ethical decision-making issues associated with prioritizing access to palliative care services. Making explicit the processes and influences upon decision-making provides greater transparency of health-care utilization at the end of life.

KEYWORDS:

ethics; palliative care; resource allocation; triage; waiting lists

PMID:
30803255
DOI:
10.1177/1049909119833333

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