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Understanding the physician treatment decision process

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The use of simulation-based cognitive interviewing in physician market research

Introduction

Understanding the physician treatment decision process is a challenge, butt one necessary to overcome if one is to effectively influence physician behavior.
Market researchers strive to determine how the factors of patient characteristics, brand perceptions and insurance coverage may influence the ultimate decision to treat, and by what degree. Or does something else cause influence? Essentially the role of the market researcher is to determine what process the physician follows, and to identify the points along the way where one can influence behavior.
The structured questionnaire approach used for quantitative research plays a key role in such analysis, but falls short of providing the broader context within which physicians make decisions. Cognitive interviewing, often underutilized, can fill the gap, providing valuable insights into the physician’s decision-making process.

Three qualitative, cognitive interviewing research approaches

Cognitive interviewing is often called the “think aloud” process as it calls for the physician to articulate the words that come to mind in completing a task. Three valid approaches to this think aloud process are explained below.

Review of Anonymous Charts
In this situation, a physician is provided with patient charts demonstrating treatments for illnesses during earlier visits. Identifying information on the actual patient is withheld. Only presenting symptoms, background information and treatment protocols are provided. The physician is asked to explain the thinking process that led to the diagnosis and / or prescribed treatment.
This approach can be effective, but is limited as the physician is now removed from the thought process that occurred when treating the actual patient. The time passed and possible memory failures can lead to less than satisfactory recall of the actual experience.


Interaction with Actors Portraying Patients
For this scenario, trained actors are hired and coached to portray patients in various stages of illness.

This methodology allows researchers to observe how physicians interact with patients and how they use the information provided. It also provides the opportunity to witness their body language and means of communication.
This approach is somewhat limited due to the expense incurred when hiring multiple actors to portray individual scenarios, and the amount of time needed to properly implement across multiple locations and geographies. If a single actor is used in the role of multiple patients, the actual interview can be compromised.
Simulation
Simulation of treatment scenarios to understand the physician decision-making process is not new to health care market research. However, the introduction of digital simulation has brought this technique to a new level of realism, producing far more valuable insights into physician behavior. These digital simulations are built around the management of virtual patients, offering a powerful approach to deeper understanding of physician behaviors and process. Rather than asking physicians what they do and why, as one might in a questionnaire, simulation allows the researcher to observe physician behavior within an engaging environment in which they treat virtual patients. Such interactions result in a real-world look into how physicians think and behave.

The digital simulation software developed by KMK Consulting offers three components to step the physician through the treatment process. The physician is asked to think out loud as he or she goes through the process, and these comments provide useful verbalization of thought processes.
A. Patient Examination
In this phase the physician receives information on the virtual patient – patient history, presentation of symptoms during the visit, lab test results, patient and patient and/or caregiver commentary on prior visits, etc.
B. Treatment Selection
Based on the information from the patient examination, the physician is offered a variety of treatment options including prescribing medication(s), surgery, diagnostic tests, referrals, etc. All information is then programmed into the simulation for review in subsequent visits.
C. Scheduling of Follow-up
After treatment is selected, the physician indicates when the patient returns for a follow-up visit.
Digital simulation in cognitive interviewing has been proven to produce more cost-effective insights into the physician decision-making process with potentially more depth and subtlety than using actors or chart simulation.

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