A Client recently asked me to weigh-in on a debate the marketing team was having regarding the role of patients in a specialty care category that was becoming more crowded with treatment options. The question was simple:
Does patient involvement in the treatment decision-making process increase or decrease as more therapies come on the market in rapid succession?
It’s a great question, especially for categories like prostate cancer or hepatitis C where multiple new product entrants have been introduced over the last 18 months. My counsel to the Client was to closely examine the potential factors that influence ownership over the treatment decision-making process.
- MD ‘Involvement’ – to what degree do physicians believe that the category is a high involvement category for them? In other words, does the physician believe his/her consideration is essential to the patient’s outcome? It’s not binary, but scaled. In categories that are low involvement for physicians (allergies), patients have the potential to play a larger ownership role.
- Patient ‘Involvement’ – to what degree do patients themselves believe that their involvement is essential to the outcome of their treatment? Classic example is breast cancer where even before women are diagnosed, they have been conditioned to believe that they should play a significant role in this disease.
- Symptomatic vs. Asymptomatic disease – to what extent does the disease itself impact the current QOL of the patient? Less impact, less patient decision-making. Classic example here is hypertension drugs. There are a ton of them, but they’ve never really been able to move the patient needle because it’s hard to secure end user involvement in this class. “I feel good and I don’t fully appreciate the risks of having high blood pressure, so I don’t understand why I should be involved.”
- Symptomatic vs. Asymptomatic treatment – to what extent does the patient feel the effects of the treatment itself? It starts with side effects, but it could also include efficacy. If multiple products in a category have varying side effects or varying dosing schedules, physicians often allow patients to play a larger role. We see this with treatments for rheumatoid arthritis that have varying toxicity profiles and modes/timing of administration. These treatments often drive increased patient involvement in the decision-making process.
The outcome of this discussion was a more structured analysis of the key questions with a listing of the corresponding hypotheses and support (or lack thereof).
What are your thoughts? What criteria am I missing?