“Some sort of fantasy land”: a qualitative investigation of appropriate prescribing in oncology.

Abstract

Increasing the appropriateness of prescribing has long been a focus of government, non-government and professional organisations. Progress towards this is made difficult by the fact appropriate prescribing remains inconsistently defined and is the subject of ongoing intense disagreement. In this study we attempted to understand why this is the case in oncology through the qualitative analysis of semi-structured interviews with 16 Australian oncologists and haematologists. We found that oncologists framed appropriate prescribing in terms of the following inter-related, and at times opposed, values: civic mindedness; hope and compassion; realism; and virtue in motivation. These values cannot be ranked a priori, and therefore what is meant by appropriate prescribing depends upon both the strength of arguments used to justify particular definitions, and the values and goals of affected communities.