ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2001
Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2001. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 21 citations in OpenAlex.
- Setting priorities in primary health care--on whose conditions? A questionnaire study.BMC family practice · 2012Article
- Priority setting in primary health care - dilemmas and opportunities: a focus group study.BMC family practice · 2010Article
- Nonclinical factors in patient selection for surgery.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2001Article
- Psychosocial patient selection criteria in clinical practice guidelines: an ethical basis for rationing?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2001Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiac procedure guidelines often include psychosocial criteria for selecting patients that potentially introduce social value judgements into clinical decisions and decisions about the rationing of care. The aim of this study was to investigate the terms and justifications for and the meanings of psychosocial patient characteristics used in cardiac procedure guidelines.
methodsWe selected English-language guidelines published since 1990 and chapters in textbooks published since 1989. These guidelines amalgamated multiple sources of evidence and expertise and made recommendations regarding patient selection for specific procedures. A multidisciplinary team of physicians and social scientists extracted passages regarding psychosocial criteria and developed categories and conceptual relationships to describe and interpret their content.
resultsSixty-five papers met the criteria for inclusion in the study. Forty-five (69%) mentioned psychosocial criteria as procedure indications or contraindications. The latter fell into several categories, including behavioural and psychological issues, relationships with significant others, financial resources, social roles and environmental circumstances.
interpretationPsychosocial characteristics are portrayed as having 2 roles in patient selection: as risk factors intrinsic to the candidate or as indicators of need for special intervention. Guidelines typically simply list psychosocial contraindications without clarifying their specific nature or providing any justification for their use. Psychosocial considerations can help in the evaluation of patients for cardiac procedures, but they become ethically controversial when used to restrict access. The use of psychosocial indications and contraindications could be improved by more precise descriptions of the psychosocial problem at issue, explanations regarding why the criterion matters and justification of the characteristic using a biological rationale or research evidence.
Indexed as
Identifiers
11258209PMC80816W2161089709What OpenQuestion holds
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