Academic journal article Applied Health Economics and Health Policy

Patient Preferences versus Physicians' Judgement: Does It Make a Difference in Healthcare Decision Making?

Academic journal article Applied Health Economics and Health Policy

Patient Preferences versus Physicians' Judgement: Does It Make a Difference in Healthcare Decision Making?

Article excerpt

Published online: 26 March 2013

© Springer International Publishing Switzerland 2013

Abstract Clinicians and public health experts make evidence-based decisions for individual patients, patient groups and even whole populations. In addition to the principles of internal and external validity (evidence), patient preferences must also influence decision making. Great Britain, Australia and Germany are currently discussing methods and procedures for valuing patient preferences in regulatory (authorization and pricing) and in health policy decision making. However, many questions remain on how to best balance patient and public preferences with physicians' judgement in healthcare and health policy decision making. For example, how to define evaluation criteria regarding the perceived value from a patient's perspective? How do physicians' fact-based opinions also reflect patients' preferences based on personal values? Can empirically grounded theories explain differences between patients and experts-and, if so, how? This article aims to identify and compare studies that used different preference elicitation methods and to highlight differences between patient and physician preferences. Therefore, studies comparing patient preferences and physician judgements were analysed in a review. This review shows a limited amount of literature analysing and comparing patient and physician preferences for healthcare interventions and outcomes. Moreover, it shows that methodology used to compare preferences is diverse. A total of 46 studies used the following methods-discrete-choice experiments, conjoint analyses, standard gamble, time trade-offs and paired comparisons-to compare patient preferences with doctor judgements. All studies were published between 1985 and 2011. Most studies reveal a disparity between the preferences of actual patients and those of physicians. For most conditions, physicians underestimated the impact of intervention characteristics on patients' decision making. Differentiated perceptions may reflect ineffective communication between the provider and the patient. This in turn may keep physicians from fully appreciating the impact of certain medical conditions on patient preferences. Because differences exist between physicians' judgement and patient preferences, it is important to incorporate the needs and wants of the patient into treatment decisions.

1 Background and Research Interest

Against the background of the consideration of patient and public preferences in health politics, the question of the congruence of patient preferences and doctor judgement remains unclear. This article provides a literature review on the state of agreement between patient preferences and physician judgement. To better promote patient-centred care, policy makers, experts and physicians need to understand patient priorities. Accordingly, this study intends to evaluate where there is agreement and where there are differences between patient preferences and physician judgement.

We are interested in whether different methods and techniques for eliciting patient preferences as well as attributes used in these studies show systematic disparities in agreement between patients and physicians.

Construal level theory describes the influence of psy- chological distance on individual thinking about technol- ogies or interventions. The theory assumes that people's decision making is abstract or concrete depending on psychological distance [1], Preferences for healthcare or health technologies might change depending on psycho- logical distance from a disease or illness. Psychological distance can be defined on several dimensions: temporal, spatial, social and hypothetical distance [2, 3], Individuals' decision making on more distant objects evokes more abstract thinking, while the opposite relation, decision making on close objects evokes more concrete thinking, is true as well.

An example of construal level effects in healthcare decision making would be that making decisions on one's healthcare intervention 1 year in advance will result in rather abstract thoughts about the therapy characteristics or attributes (e. …

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