Mind Reading: Exploring the Psyche of the Patient

Understanding what patients think and feel about their disease and medications is leading to tailored support programs that effectively improve patient outcomes

The role of the patient in managing their health is changing fast. Fueled by technology, empowered patients are demanding more involvement in decision making in optimize their health outcomes. Fueled by rising costs and constrained budgets, healthcare systems want patients to monitor their health, improve their lifestyles and adhere to their medications.

With the rise of patient-centricity and ever-greater understanding of the patient journey, there has never been a more important time for pharmaceutical companies to offer patient support programs that meaningfully impact patients’ lives.

Tailoring support programs to the individual needs of patients is integral to their success, says Lisa Egbuonu-Davis, Vice President of Global Patient-Centered Outcomes and Solutions at Sanofi.

“We are seeing patients take an increasing role in managing their disease,” she says. “In diabetes, for example, at least 50 percent of outcomes are determined by patient behavior – what you eat, how you move, how you manage your life and stress. These actions, and medication adherence, will significantly impact the effectiveness of medications. Patients’ need for information and connectivity, their demand for participation in self-management and decision making, and their motivations and expectations must be addressed if you are going to have a solution that has value and improves outcomes.”

To better understand the patient experience, companies are turning to behavioral science, exploring the motives behind potentially puzzling behaviors such as why so many diagnosed patients fail to take their prescribed medication.

“Beliefs drive behavior,” says Gabor Purman, Associate Director with the Patient Solution Team at Teva. “You can only change behavior if you change beliefs first. If you want to make a patient support program really impactful, you need to explore the context in the mind of the patient.”

He points to a study where 55 percent of asthma patients in Europe reported feeling “victorious” when they missed a dose of their maintenance medication. “It’s not that they forget – they don’t want to take their meds, and they feel happy when they don’t take them. You can imagine that sending a message reminding them to take their medication would be completely annoying. They will sign off from the program because they don’t want to take the treatment as they do not see it necessary. We need to figure out what patients consider about their illness and medications.”

Understanding how people feel about their condition is the first step when designing support programs. This includes patients’ perception of their disease – how long will it last, how will it impact their life? – and their belief in their medication – is it a necessity and/or do they have a high level of concern? The answers to these questions reveal that there is no one-size-fits-all approach; even for those who share a diagnosis or are undergoing similar treatment, the diversity of experience can be vast.

Made to measure

Personalized, tailor-made support packages that consider the needs of individual patients and the trajectory of their illnesses are required, says Nagore Fernandez, Head of Clinical Services for Europe at Ashfield, part of UDG Healthcare. She advocates building programs around the patient journey and focusing support (and increased contact) around therapy failure points to try and overcome them, asking, ‘What’s the window in which we can lose our patients?’

“Nothing can replace insights from real people,” she says. “Human behavior can be irrational at the best of times, let alone when there is fear, medication and a diagnosis of a disease. We need more insights into how patients think, feel and behave, but we also need the behavioral change and health psychology expertise to be able to diagnose the problems and design solutions. Then you have to have a consistent approach throughout the journey of your patient support program.”

It is no longer enough to maintain contact with patients and provide generic information; to improve outcomes – and keep stakeholders happy – programs must offer relevant, targeted content to patients in a focused route. The type of information patients receive can vary according to age, stage of disease or even the kind of food a person might like.

A pilot program that supports patients starting insulin treatment is exploring how to tailor messages about medicines, diet and lifestyle changes based on cultural background, says Egbuonu-Davis. “Food and language are critical expressions of culture, so the language we use when we talk about interventions and change, and the foods we suggest to people with diabetes to adapt their diet and lifestyle, need to be culturally appropriate.”

Ethnic and racial minorities have a higher risk of developing Type 2 diabetes and are also at risk of poor diabetes outcomes. African Americans, Hispanics and South Asians are some of the fastest growing groups of people developing Type 2 diabetes in the United States, but are often missed in traditional messaging. In some communities, levels of trust in both healthcare providers and medicines remain low; this makes it is even more important to tailor messaging to increase engagement.

Sanofi’s short instructional videos, shown to patients as they begin their insulin journey, feature a diverse range of patients and healthcare providers, environments and foods, and include both clips of real people as well as cartoons with subtitles to personalize the experience.

A similar approach has been taken at Israeli start-up Telesofia Medical, where tailored advice is presented to patients in instructional videos sent out by email or text. A large bank of prerecorded videos contain both male and female subjects, and feature specific dosages for drugs, so that a different video can be directed to a man prescribed 60ml and a young girl on a 20ml dosage. Using demographics, lab results, medical instructions and medications prescribed, videos can be customized to a patient.

Cutting through the noise

We are all saturated with information across multiple platforms from the moment we wake to when our heads hit the pillow at night, and it has become second nature to filter out the ‘noise’. Support programs that deliver vital medical content must, therefore, be attractive or will be ignored.

Maintaining communication with patients is best practiced using multiple channels, says Teva’s Gabor Purman, including phone calls from nurses, traditional print (which some people still prefer) and the wealth of digital offerings from email and text through to interactive online programs and apps.

“A combination of those channels is really impactful; it makes sense to have a couple of phone calls in the beginning then phase out to digital channels,” he says. “Or maybe, for patients who understand the necessity of the treatment and don’t have major concerns, we don’t need those phone calls. We can tailor-make the content and channels to patients based on the context.”

Technology can help pharma provide individual support to patients throughout their treatment, improving self-management and consequently health itself. For Purman, a patient support system is simple: “You need to figure out the context, you need to develop great, relevant content and deliver through multiple channels. That’s our secret formula and we hope that will deliver a lot of value to patients. For us, when we improve the quality of life of patients, it will impact the healthcare system and society, and it will probably impact us [Teva] as well.”

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