The desirability of being open about health care rationing decisions: findings from a qualitative study of patients and clinical professionals

Objective: To understand the views of patients and professionals about how feasible and appropriate it is to make health care rationing decisions openly at the consultation level. Methods: Thirty-one patients and 21 health care professionals were asked about their experiences of implicit and explicit rationing during in-depth interviews structured around two clinical case studies (morbid obesity and breast cancer). Sampling was undertaken theoretically and data analysis was carried out using constant comparison. Results: Patients had a broad awareness of health care rationing and nearly all said they wanted to know how financial factors affected the provision of their health care. However, the experience of explicit rationing could be distressing and one patient regretted having been told. Despite a firm commitment to the ideal of being open with patients about rationing, in practice, clinical professionals encountered a number of ethical and practical barriers to making such decisions explicitly, meaning that implicit methods were frequently adopted. Conclusions: The results suggest that moves in the UK and elsewhere to undertake rationing more explicitly are in line with the preferences of the majority of patients and professionals. However, the potential for distress caused through rationing openly means that further research is needed to understand whether explicitness is always the best approach at the consultation level, and professionals need further training and support to deal with the stressful nature of making rationing decisions openly.