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 (1) impact of scarce resources on patient care, (2) clinical decision-making, and (3) 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, 2016 and 2017. group 1 represented 331 physicians from different departments at one university hospital and group 2 consisted of 923 members of the society of cardiology. results  overall, a 26% (328/1254) response rate was achieved, 49% in group 1 (162/331), 18% in group 2 (166/923). scarcity of resources was perceived by 59% more often than ‘at least once per month,’ whilst 60% felt less than ‘wellprepared’ to address this issue. guidelines in general had a lot of influence and 19% perceived them as limiting decisionmaking. 86% professed to be mostly independent in decision-making. 36% knew the ethical platform ‘well’ and ‘very well’ and 64% nbhw’s national guidelines. 57% expressed a wish for further knowledge and training regarding the ethical platform and 51% 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.