Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values

Abstract

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. Additionally, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment which could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decisionmaking and provide examples of how these impact provision of healthcare. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision-making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both for overall healthcare delivery and for shared decision making, as value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision-making and facilitates a more complete value assessment at the point of care.

Measuring Value in Health Care: A Comparative Analysis of Value-based Frameworks

“…The NCCN model is also addressed to patients and clinicians, but the evaluations and guidelines seem to be developed beforehand, with the engagement of only few patients' representatives, and still far from the final treatment decision. Consistently with other researchers, 23,24 we suggest that giving a voice to patients in assessing the value of care would probably not require them to use a predesigned formula and tools, but rather engage them both at the point of care and early on to decide which dimensions of value really matter to them.…”

A Review of Patient-Reported Outcome Data for Palliative Cancer Drugs Approved In the European Union

“…In EU calls for policy changes in HTA models are rising. Recent EU, WHO and others findings highlight inconsistency, variability and lack of predictability in the current HTA value frameworks urging authorities to encompass all attributes recommended by the EUnetHTA Core Model® where patient perspective, including PRO, should be considered [10][11][12][13][14][15][16][17][18][19].…”

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“…The most useful constructs would allow patients to differentiate among options available to them using value elements relevant to their preferences or the shared decision-making context. Armstrong and Mullins [36], for example, suggest a logical way to group such elements into global, decisional, situational, and external components. Ideally, those elements would need weighting by patient-specific preferences to lead to genuinely individualized decisions.…”