ArticleBMJ open2026
Understanding citizens' preferences for prioritising patients in the face of scarce surgical capacity in the Netherlands: a think-aloud study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesScarce surgical capacity makes prioritisation decisions unavoidable. During crises, the complexity and societal sensitivity of such decisions become particularly evident, underscoring the importance of engaging multiple stakeholders, including citizens. Citizens may hold different preferences and attach importance to different considerations than physicians regarding what is fair or appropriate when allocating scarce surgical capacity. This study, therefore, examined which preferences and considerations citizens consider important in decisions about prioritising patients for limited surgical capacity.
designWe conducted semi-structured think-aloud interviews in which participants completed two sets of 12 labelled choice tasks derived from a discrete choice experiment. In the first set, they prioritised one of three patients with different conditions (breast cancer, deafness and knee arthrosis) for limited surgical capacity. In the second, they prioritised one of two patients with the same condition (breast cancer, deafness or knee arthrosis).
settingThe setting of the study was in the Netherlands.
participants25 citizens were purposively sampled.
resultsWe developed a framework comprising 13 categories grouped under five themes that provided insight into how participants (A) performed the choice tasks, (B) perceived the patients, (C) perceived the conditions, (D) perceived the treatment options and (E) stated a preference.
conclusionsOur study shows that rather than relying solely on the attributes presented in the choice tasks, participants integrated a wide array of contextual, emotional and ethical factors into their decision-making. Perceived disease severity was of specific importance to citizens. Our findings further suggest that citizens not only draw from principles of utilitarianism but also draw from principles of prioritarianism.
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