Table 2 The identified statements
Themes | # | Statement | Context |
|---|---|---|---|
Patients’ need for treatment | 1 | An ill medical condition can make a physician’s decision to withdraw or withhold a treatment easier | PHY/POR |
2 | An ill medical condition can make the physician more willing to take higher risks and not withhold treatments | PHY | |
3 | It might be easier for both the physician and the patient when withdrawing or withholding a treatment from a patient if alternative treatments exist | PHY/POR | |
4 | The patient’s quality of life is important when deciding to withdraw or withhold treatment | PHY/POR | |
Treatment effect in relation to alternative treatments | 5 | The healthcare sector provides inefficient treatments to patients | PHY/POR |
6 | Treatments are commonly withdrawn too late from patients in practice | PHY/POR | |
7 | Physicians sometimes withhold treatments from patients due to cost-effectiveness | PHY/POR | |
8 | Physicians sometimes withdraw treatments from patients due to cost-effectiveness | PHY/POR | |
9 | Physicians commonly withdraw treatments from patients because they are ineffective or cause harm, rather than for cost-effectiveness reasons | PHY/POR | |
10 | A treatment that has been proven to be ineffective for a specific patient should be withdrawn | PHY/POR | |
11 | It must be acceptable for physicians to withdraw ineffective treatments | PHY/POR | |
12 | A treatment that has proven to be effective for a specific patient should not be withdrawn by the healthcare service, even if it is not reimbursed | PHY/POR | |
13 | A treatment that has proven to be effective for a patient participating in a clinical study should not be withdrawn | PHY/POR | |
14 | Patients can understand if a treatment is withdrawn after a clinical study | POR | |
15 | The expected net patient benefit of a treatment can affect the physician’s decision to withdraw or withhold a treatment | PHY | |
16 | It can be helpful for a physician to evaluate a treatment’s effects when deciding to withdraw a treatment | PHY/POR | |
17 | It can be difficult for a physician to evaluate all effects a treatment has or will have for a patient | PHY/POR | |
18 | The use of one treatment can exclude the use of alternative treatments | POR | |
Patient–professional communication | 19 | Involving patients in decision-making can facilitate withdrawals | PHY/POR |
20 | Agreements between a physician and a patient can facilitate treatment withdrawals | PHY/POR | |
21 | Agreements between a physician and a patient can be the difference between withdrawing and withholding treatments | POR | |
22 | It can be easier to withdraw a treatment if the physician informs the patient of the conditions for the treatment before starting it | PHY/POR | |
23 | It is easier for the physician to withdraw treatments if the patient understands the information given to them | PHY/POR | |
Patient–professional relationship | 24 | The physician should represent the patient when deciding to withdraw or withhold treatments | PHY/POR |
25 | Having a relationship between the physician and the patient can facilitate treatment withdrawal | PHY/POR | |
26 | Spending extra time to support a patient psychologically makes it easier for the patient if their treatment is withdrawn | POR | |
27 | It can be comforting for relatives if the physician decides whether a treatment is withdrawn or withheld | PHY | |
28 | Having too close a relationship between the physician and the patient can make the physician act unprofessionally when withdrawing a treatment | PHY | |
29 | The physical meeting with patients makes it more difficult for physicians to decide to withdraw or withhold treatments for specific patients than for patient groups | PHY/POR | |
Healthcare responsibility | 30 | It is a physician’s obligation to withdraw ineffective or harmful treatments | PHY/POR |
31 | A physician has more obligations when prescribing unofficial treatments to patients | PHY/POR | |
32 | Patients might lose confidence in the healthcare system if effective treatments are withdrawn because of reimbursement status | PHY | |
33 | Expensive treatments should be publicly funded | POR | |
34 | The pharmaceutical company should finance effective treatments for patients after a study is completed until an official recommendation is given | PHY/POR | |
Ethical values | 35 | It is psychologically easier to withhold a treatment due to cost-effectiveness than to withdraw it | PHY/POR |
36 | There is an ethical difference between withdrawing and withholding treatments due to a lack of cost-effectiveness | PHY/POR | |
37 | It is more important for physicians to make an individual assessment for patients with previous access to treatments that lack cost-effectiveness than to withdraw treatments to uphold patient equality | PHY/POR | |
38 | Patients might not experience the same human value if their treatments are withdrawn due to a lack of cost-effectiveness | POR | |
39 | Withdrawing and withholding treatments differently might lead to patients seeking healthcare from other healthcare providers | PHY/POR | |
40 | It is unjust when different healthcare providers withdraw and withhold treatments unequally | PHY/POR | |
Professional support | 41 | Physicians feel alone when deciding to withdraw or withhold treatments | PHY |
42 | It can be helpful for a physician to consult other physicians when deciding to withdraw or withhold treatments | PHY | |
43 | Guidelines from a national level on treating new patients and patients with previous access to treatments after new recommendations can facilitate treatment withdrawals for physicians and patients | PHY/POR | |
44 | Guidelines from a national level should be accessible for physicians | PHY | |
45 | Guidelines from a national level may not be applicable in all healthcare scenarios | POR | |
46 | It could be helpful for a physician to have reflected on ethical problems related to priorities when making priority decisions | PHY/POR | |
Reimbursement system | 47 | Physicians and patient organization representatives are supportive of healthcare making priority decisions | PHY/POR |
48 | Physicians tend to prioritize their own patient groups | PHY | |
49 | Patient organizations represent their own patient groups | POR | |
50 | The treatment assessment process is not sufficiently transparent for patients | POR | |
51 | Patients are not sufficiently involved in the treatment assessment process | POR | |
52 | Patients want access to new treatments | POR | |
53 | It takes a long time for authorities to implement new treatments | PHY/POR | |
54 | A patient cannot demand access to the experimental treatment in a clinical study | PHY/POR | |
55 | There is a difference between what is medically best and what is practically possible when prioritizing treatments between patients | PHY/POR |