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Prevalence and determinants of physician bedside rationing
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Hurst, S. A., Slowther, Anne, Forde, Reidun, Pegoraro, Renzo, Reiter-Theil, Stella, Perrier, Arnaud, Garrett-Mayer, Elizabeth and Danis, Marion (2006) Prevalence and determinants of physician bedside rationing. Journal of General Internal Medicine, 21 (11). pp. 1138-1143. doi:10.1111/j.1525-1497.2006.00551.x ISSN 0884-8734.
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Official URL: http://dx.doi.org/10.1111/j.1525-1497.2006.00551.x
Abstract
BACKGROUND:
Bedside rationing by physicians is controversial. The debate, however, is clouded by lack of information regarding the extent and character of bedside rationing.
DESIGN, SETTING, AND PARTICIPANTS:
We developed a survey instrument to examine the frequency, criteria, and strategies used for bedside rationing. Content validity was assessed through expert assessment and scales were tested for internal consistency. The questionnaire was translated and administered to General Internists in Norway, Switzerland, Italy, and the United Kingdom. Logistic regression was used to identify the variables associated with reported rationing.
RESULTS:
Survey respondents (N=656, response rate 43%) ranged in age from 28 to 82, and averaged 25 years in practice. Most respondents (82.3%) showed some degree of agreement with rationing, and 56.3% reported that they did ration interventions. The most frequently mentioned criteria for rationing were a small expected benefit (82.3%), low chances of success (79.8%), an intervention intended to prolong life when quality of life is low (70.6%), and a patient over 85 years of age (70%). The frequency of rationing by clinicians was positively correlated with perceived scarcity of resources (odds ratio [OR]=1.11, 95% confidence interval [CI] 1.06 to 1.16), perceived pressure to ration (OR=2.14, 95% CI 1.52 to 3.01), and agreement with rationing (OR=1.13, 95% CI 1.05 to 1.23).
CONCLUSION:
Bedside rationing is prevalent in all surveyed European countries and varies with physician attitudes and resource availability. The prevalence of physician bedside rationing, which presents physicians with difficult moral dilemmas, highlights the importance of discussions regarding how to ration care in the most ethically justifiable manner
Item Type: | Journal Article | ||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Journal of General Internal Medicine | ||||||||
Publisher: | Springer New York LLC | ||||||||
ISSN: | 0884-8734 | ||||||||
Official Date: | 2006 | ||||||||
Dates: |
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Volume: | 21 | ||||||||
Number: | 11 | ||||||||
Page Range: | pp. 1138-1143 | ||||||||
DOI: | 10.1111/j.1525-1497.2006.00551.x | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Open Access Version: |
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