Physicians’ Perspectives on Ethical Issues Regarding Expensive Anti-Cancer Treatments: A Qualitative Study

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Background: When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists. Methods: A diverse sample of oncologists and hematologists (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software. Results: This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not. Conclusion: Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas.

Original languageEnglish
Pages (from-to)275-286
Number of pages12
JournalAJOB Empirical Bioethics
Issue number4
Early online date26 Aug 2022
Publication statusPublished - 2022

Bibliographical note

Funding Information: This study is a result of the research project ‘Ethical access and reimbursement models for expensive new cancer treatments: How to reconcile diverging values?’, which was funded by the Dutch Cancer Society, project number 12473 (2020-2023).

Publisher Copyright: © 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.


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