A psychology perspective introduction to patient preferences
Patient preferences, presenting the needs, expectations and priorities of patients, are gaining critical importance as a hard facts instrument for regulatory agencies to evaluate risk-benefit-ratios, price and reimbursement approvals for health services and supporting decision-making of the payers, the Federal Joint Committee and statutory health funds – on the backdrop of sharp health care expenditures with older demographics, chronic morbidity and common illnesses statistics. Institutionalizing patient priorities as the evaluating criteria directly links the microeconomic level to the macroeconomic level of the public good in the prioritizing and restructuring of the regulatory healthcare system – „by those affected to those affected“ and for the public good.
Psychological assumptions in patient preferences
Patient preferences studies measure which characteristics of health interventions patients choose or prefer between alternative options.
To directly ask patients about their preferences thus institutionalizing them to decision-makers about health alternatives is based on the assumption that in the end the patients are those concerned and those to accept and use a health service.
Even though the patient is no longer held as the sovereign of therapy choices who despite potential asymmetries is overlooking the health-related implications and interdependencies of their preferences, and even if experts might be the competent party to do so, their personal health situation along with their individual and illness-driven motivational state is a different one. Everybody knows that illnesses instill reacting different from someone not affected; they mean aggravated living conditions, just as they can have their own, personal or secondary gain value. And patients somehow have to cope with their illness-related life situation.
This concludes to a basic assumption: that patients, as the one’s affected, best know what is good for them. As a result, which is the other basic assumption, choosing between health service alternatives, they choose what is best for them. And best for them is what best covers their individual needs. In terms of patient benefits, this is the maximum benefit-promising alternative.
„Maximization of benefits forms the basis for measuring preferences- and benefits in healthcare, as well.” [1] Which assumes “that the respondent chooses those products/services which provide them with the maximum benefits. This requires that everybody is accordingly able to act rationally.” [2]
Conflicting, pre- and subconscious motivations as driving factors in the equation
The assumption behind is, what they choose is what they prefer, is what they need, is what motivates them to use it, and to comply to and compliance means better efficiency and higher outcomes and also better resource-cost-values.
The deeper these efficiency equations go, the more they go into the terrain of socio-psychological and psychographic logic. What does “satisfaction of needs“ actually mean and what is the impact of pre- and sub-conscious drivers on the “rational” benefit-based decision-making?
People are not patients – they become patients, and much so over their life history. Being familiar with illness patterns and patients shows that the concept of motivations driving choices and behavior applies – with psychology being the science of the interrelations between experience and behavior – but whether or not patients decide for their best benefit is for the qualitative phase of preference studies to assess in clarity.
Motivations can be emotional, contradictory, ambiguous and “illogical”, depending on the illness pattern concerned and on related psycho-graphic types, no matter whether or not patients understanding of how a therapy works or not. Just as easy as it is to give good advice on healthier living, as difficult is it to put it into practice.
A major issue with diabetes type 2 OAD patients (oral anti-diabetics) facing IAD (injectable anti-diabetics) is to what extent e.g. frustrations and fears or further weight gain as an IAD side effect are driving OAD patients preferences. [3]
Psychological In-depth Research Value: “Everybody talks about the value of health, but how about the value of the illness?”
To gain clarity here is the “added benefit” of an in-depth psychologically sound study phase before the actual discrete choice experiment. Patient preference studies are directly building on a holistic and close-to-live understanding of the situation of the patient-citizen concerned with the illness. A sensible and decision-relevant assessment of preferences requires an in-depth understanding of the patient-illness-ecosystem, which is how illness and therapy directly affect the individual condition and quality of life. In other words, the motivations, hopes, fears, habits and needs of the patients with regard to the illness specifics and the impact of different health solutions. Technically, this requires assessing the dynamics of illness profiles, psychographic factors from lifestyle, attitudes, values and personality types. This allows also understanding how patients relate preference to e.g. specific drug characteristics and whether or not they are able to overlook the resulting personal benefits. Our experience shows that these insights remain the vital „real life“ reference source throughout the course of interpreting the conjoint results, just as the standard questionnaires have become.
Mutual re-forming of patient preference concepts and treatment cultures
Costs are the quantifiable part of health care reality. The restructuring of health care regulations will also change the traditional treatment cultures and vice versa, esp. with the changes to connected care. Studies assessing the driving changes and socio-psychological dynamics will be of larger value for guiding support and comprehensive recommendations for actions alongside these transitory stages.
Whether traditional doctor-patient-relationship, telemedicine, medical health applications, community or patient-expert-forums, the diversity of forthcoming “channels” and “mediums” will remodel illness patterns and their relevant treatment strategies.
Marketing to HCP – from promotion to research-based benefit argumentation
As a result, a benefit-based treatment argumentation becomes a major marketing proposition with the prescribing doctors. If they perceive the benefits for their individual patients and the cost situation, their patient focus as well is getting enlarged.
Patient outcomes and benefit benefits also restructure how to go about marketing and promotion. Talking about patient needs, benefits and motivational compliance issues means discussing on more objective discussion grounds how patients and doctors can use the advantages of a health service and what to watch out for. It is directly useful in the daily life in the practice when “treating” the patients.
PREFERENCES and REGULATIONS – RESULT
Patient preference studies are not the standard market research study. They present a much higher degree of research responsibility and many more and intertwined steps within the overall research proceeding. Academic, and often university experts advise or co-conduct them along with the companies for applicable procedural standards, such as discrete choice experiments methods, conjoint analyses types and defining attributes and levels for health options.
Both, high competence in assessing the relevant patient-illness ecosystem, the motivators, hopes, fears and habits and needs of the patients, developing an attribute-level-matrix and designing the experiment with the adequate statistical instruments is in demand. Pharmaceutical know-how, strategic thinking, advanced qualitative and quantitative competences need each other to provide the end information.
Preference studies tend to be tricky and complex. They profit from an informed, yet empathic embracing of the very condition of patient-citizens, the ever-existing range of contradictions, conflicts and common logics of the human condition.
