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Procedural fairness for radiotherapy priority setting in a low resource context.

Rebecca J DeBoer1, Cam Nguyen2, Espérance Mutoniwase3

  • 1Division of Hematology/Oncology, University of California San Francisco, San Francisco, California, USA.

Bioethics
|August 20, 2021
PubMed
Summary

Limited radiotherapy resources necessitate fair patient prioritization. In Rwanda, decision-makers prioritize objective criteria for saving lives, but implementing fair procedures faces challenges and requires context-specific solutions.

Keywords:
Accountability for ReasonablenessRwandaglobal healthpriority settingradiotherapyresource allocation

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Area of Science:

  • Oncology
  • Health Services Research
  • Global Health

Background:

  • Radiotherapy is crucial for cancer care but faces global capacity shortages, especially in low-resource settings.
  • Effective priority-setting mechanisms are needed for equitable radiotherapy access, but consensus is lacking.
  • Understanding decision-makers' perspectives on procedural fairness is vital for improving radiotherapy allocation.

Purpose of the Study:

  • To explore radiotherapy decision-makers' views on priority-setting procedures in Rwanda.
  • To assess facilitators, barriers, and recommendations for fair radiotherapy allocation.
  • To evaluate findings within the Accountability for Reasonableness (AFR) framework.

Main Methods:

  • Semi-structured interviews conducted with 22 healthcare professionals and advisors involved in radiotherapy priority setting.
  • Evaluation of radiotherapy priority-setting procedures at program (meso) and patient (micro) levels.
  • Analysis of findings in relation to the Accountability for Reasonableness (AFR) framework.

Main Results:

  • Decision-makers favored objective criteria maximizing lives saved, aligning with AFR's relevance principle.
  • Transparency, appeals, and enforcement were less emphasized than relevance.
  • Challenges included conflicting rationales, unintended consequences of publicity/appeals, and the resource-intensive nature of fair procedures.

Conclusions:

  • Implementing fair radiotherapy priority setting in low-resource contexts requires innovative, context-appropriate solutions.
  • Socioeconomic and structural barriers significantly impact procedural fairness and must be addressed.
  • Further research is needed to refine fair procedures and overcome implementation hurdles.