125:oral What makes an illness severe? Subjective accounts of severity in the Norwegian population

Introduction

‘Severity’ is one of three priority-setting criteria in the Norwegian priority-setting system. How we interpret and apply these criteria have a direct impact on which interventions are available in hospitals–and especially so for high-cost interventions, where the severity of a condition is often the justification for implementing a particularly costly treatment. However, severity is a multifaceted and incompletely defined concept. Our aim is to explore what severity means to the general, so at to better inform decision-makers on how to apply the severity criterion.

Methods

We used Q-Methodology to explore subjective views on severity in the population. We conducted focus group interviews across Norway and extracted statements from participants which will be used for a Q-sorting exercise: asking a second set of participants do what degree they agree/disagree with those statements. These results will be subjected to factor analysis, which will identify certain ‘clusters of opinion’–or factors–on the matter of severity.

Results

The project is on-going, but our findings thus far suggest that matters such as death and young age are generally considered to be severe. The most interesting finding, however, is perhaps that participants tend to consider severity as an entirely subjective concept: that severity cannot be defined on a general basis, and is subject to what each individual feels is severe in their situation. We will explore this further in the Q-sort.

Discussion

For priority-setting criteria to be applied fairly and effectively, we need a thorough understanding of what they mean. Our findings thus far suggest that severity is a concept the Norwegian public finds particularly complex, and unfit to be defined on a general level. This might suggest that the current application of the criterion is unsatisfactory, if the priority-setting system aims to have a democratically legitimate foundation.