Perspectives, priorities and plurality...Perspectives, priorities and plurality What matters to...
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Rachel Baker Professor of Health Economics Yunus Centre for Social Business & Health Perspectives, priorities and plurality What matters to people: priorities for individuals, communities and populations Priorities 2016
Transcript of Perspectives, priorities and plurality...Perspectives, priorities and plurality What matters to...
Rachel Baker
Professor of Health Economics
Yunus Centre for Social Business & Health
Perspectives, priorities and plurality
What matters to people: priorities for individuals,
communities and populations
Priorities 2016
Some background
Using Q methodology to investigate societal
viewpoints and the relative value of life extension for
patients with terminal illness
MRC Methodology Panel funding 2011-2014 Rachel Baker, Helen Mason, Neil McHugh, Cam Donaldson, Laura Williamson, Jon Godwin, (GCU) Marissa Collins, Rohan Deogaonkar Job van Exel (Erasmus, Rotterdam) Cathy Hutchinson (Beatson Cancer Centre)
Perspectives, Priorities and Plurality
Societal values and priority setting
• And use of terms: values/viewpoints, preferences/perspectives
End of life – a case in point
• End of life policy and claims about societal values (2009)
• Research evidence (2010-2016)
Plurality and societal values
• Evidence of plurality in preferences and perspectives
• Policy dilemmas and possible directions
• Future research agenda
TERMS value values viewpoints
preferences principles perspectives
METHODS
willingness to pay Q methodology depth interviews
choice exercises Q-to-survey methods focus groups
person trade off… … citizens juries..
Societal values: terms and methods
Measureable
Quantitative
Aggregation
Narrative
Qualitative
Individual
NICE End of life supplementary
guidance 2009
Specific criteria
• less than 2 years to live
• treatments would result in a gain of at least 3 months of increased life expectancy
• drug is licensed for a relatively small patient group
Legitmacy and societal values
• “The Institute recognises that the public,
generally, places special value on treatments
that prolong life – even for a few months – at
the end of life, as long as that extension of life is
of reasonable quality (at least pain-free if not
disability-free). NICE has therefore provided its
advisory bodies with supplementary advice about
the circumstances under which they should
consider advising, as cost-effective, treatments
costing >£30,000 per QALY.”
Rawlins et al Brit j of Clinical Pharmacology 2010 p 348
Research evidence since 2009
…is mixed!
Using Q methodology to investigate societal
viewpoints and the relative value of life extension for
patients with terminal illness
MRC Methodology Panel funding 2011-2014 Rachel Baker, Helen Mason, Neil McHugh, Cam Donaldson, Laura Williamson, Jon Godwin, (GCU) Marissa Collins, Rohan Deogaonkar Job van Exel (Erasmus, Rotterdam) Cathy Hutchinson (Beatson Cancer Centre)
Using Q methodology to investigate societal
viewpoints and the relative value of life extension for
patients with terminal illness
Using Q methodology to investigate societal
viewpoints and the relative value of life extension for
patients with terminal illness
www.gcu.ac.uk/endoflife
Q Methodology
FACTOR A
FACTOR B
FACTOR C
Three perspectives on the relative value of life
extension at the end of life
V3: “Valuing wider benefits and opportunity cost – the quality of life and death”
V1: “A population perspective – value for money, no special cases .”
V2: “Life is precious – valuing life-extension and patient choice”
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Q-to-Survey (Q2S) findings
Viewpoint Number of
respondents %
1 1808 37
2 2416 49
3 456 9
MIXED 231 5
TOTAL
4911
100
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Quantitative evidence of plurality
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Dilemma – incorporating (plural) societal
values into policies and decisions?
1. Majoritarian approaches
2. Ethical analysis (and the role of societal values?)
3. Deliberative methods (and the role of societal
values?)
4. Critical analysis of societal values - consistency and
consensus in empirical data (principles, policies,
patients)
Dilemma – incorporating (plural) societal
values into policies and decisions?
1. Majoritarian approaches
2. Ethical analysis (and the role of societal values?)
3. Deliberative methods (and the role of societal
values?)
4. Critical analysis of societal values - consistency
and consensus in empirical data (principles,
policies, patients)
High level PRINCIPLES Theory
Mid level POLICIES Operation
Low level PATIENTS Case
Multi-level study of social values and resource allocation in health care
Dilemma – incorporating (plural) societal
values into policies and decisions?
1. Majoritarian approaches
2. Ethical analysis (and the role of societal values?)
3. Deliberative methods (and the role of societal
values?)
4. Critical analysis of societal values - consistency
and consensus in empirical data (principles,
policies, patients)
