The words they live by

Editor's note: Jim Hickey is senior director client services at Verilogue, a Horsham, Pa., research firm.

Understanding the patient journey has become an enduring mantra of pharmaceutical companies and health-and-wellness organizations throughout the world. To understand the patient journey is to know your customers in a more intimate way, from the emotions they are feeling about a new diagnosis to the challenges and struggles they face every day while trying to manage a chronic disease or cope with a debilitating illness.

The patient journey also sheds light on the challenges that both health care professionals and caregivers face while working to ensure better outcomes for the patients in their lives. As many pharmaceutical companies adopt a customer-centric focus, understanding the patient journey has never been more critical to creating powerful marketing strategies, developing effective educational materials and fine-tuning sales training models.

But what’s the best way for your brand to gain access and truly understand the myriad of points along the patient journey? How can your team tap into all of the invaluable insights the patient journey has to offer?

As pharmaceutical market researchers, our most authentic understanding of the patient journey is framed by the words patients and their health care providers use to describe their illness. What a patient says to a physician about how he or she feels, what a physician says to a patient about the nature of an illness – these words help each person understand the nature of the illness, the treatment and the range of possible outcomes.

But there is not always a perfect exchange of information in these conversations. What a physician hears may not quite capture the experience the patient is trying to express and what a patient hears may not reflect the insight that the physician intends to convey. Ethnographic market research, observing customers in their natural environment, has helped many pharmaceutical brands break down these communication gaps by better understanding the patient journey from the participant’s unique point of view. In turn, they can communicate with doctors and patients within a framework of a narrative that is most meaningful to the patients.

While the conversations captured in the physician’s office are critical, more insight can be gained from an analysis of other conversations:

  • What about conversations outside the office?
  • What illness narrative emerges from conversations in the home?
  • What is the illness narrative that patients recount to themselves?

All of these conversations are important but none of these conversations may be complete by themselves. Considered together, they provide much deeper insights than any single set of conversations by themselves.

Multiple vantage points

To deliver the deeper insights that today’s pharmaceutical brands need, market researchers must leverage a multi-method research approach, an approach which offers multiple vantage points delivered by in-office dialogue analysis, in-home ethnographic observation and telephone-based depth interviews (TDIs). Chronologically layered together, these powerful methodologies inform one another to yield deep insight into the patient journey. By observing these distinct, natural environments, a multi-method approach enables you to compare what patients tell their physicians versus their actual behavior outside the exam room – revealing deep insights and bringing your brand closer to the challenges patients face every day.

Stage 1: In-office dialogue capture

Exam-room interactions are the epicenter of health care. It is here that dialogue reveals the patient’s illness burden by exploring their raw emotions and unique perspectives in all phases of a disease. When it comes to the needs of market researchers, what’s being said – or not being said – has the power to inform, enlighten and strengthen the decisions you make about your brand in a way that traditional marketing research simply can’t.

Working with physicians all over the world, dialogue research providers like Verilogue capture hundreds of exam-room conversations each month. Physicians are asked to record certain types of patient conversations with patients who have agreed to be recorded but are not asked to shape their conversations in any specific manner. Trained medical linguists then analyze the recordings to shed light on the patient journey, exploring underlying emotions, motivations and common behaviors.

Stage 2: In-home observation

In-home observation provides an opportunity to start to answer a critical question: What’s going on outside the exam room? By observing patients in their home environment, a trained ethnographer can gain insight into aspects of the patient journey that lie deep beneath the surface – including aspects of the illness narrative that even patients themselves may be unaware of.

In-home observational studies take up where exam-room conversations leave off, engaging patients who have participated in the previously-mentioned dialogue studies. Using guided questions as well as planned activities and exercises, the trained observer can delve deeper, capturing both the participant’s spoken and physical responses and actions to the questions and tasks. Examining how a patient modifies and interacts with their natural environment speaks to the nature of the illness narrative in many ways that words cannot.

In addition to the insights that the observer can capture through guided exercises, patients can be provided with video equipment they use themselves to create video diaries of their thoughts and activities, recorded when no one else is present. The absence of an observer empowers and encourages patients and caregivers to say things they might not say in front of another individual. The removal of a researcher also enables participants to tell their stories in their own words and to say things in the moment. If they have a sudden insight into the nature of the illness with which they are struggling, the video diary provides a mechanism for capturing that insight, even if no external observer is present.

Stage 3: Tele-depth interviews

The third and final stage of 360-degree market research, follow-up telephone interviews with study participants, further clarifies and extends the insights gained from previous stages of research.

That’s an important distinction: These are dialogue-informed tele-depth interviews (TDIs). They take place after much dialogue, both at home and in the office, has been collected and analyzed and they involve the same patients who have been participating in the study all along. As such, the interview questions are steeped in an existing reality. The responses extend that reality and enable a deeper understanding of both the individual’s journey as well as the broader perspective that all the patients with this condition may share.

Case study: the identity crisis of depression patients

A global pharmaceutical client engaged our firm to take a deeper look at the ways in which depression patients viewed their condition and to provide some actionable insights that the client could use to communicate more effectively with patients and their physicians. The initial analysis of exam-room dialogues suggested that patients suffering from depression saw it as more than just a slump or a profound sense of hopelessness. A recurring theme in the recorded physician-patient dialogues suggested that patients experienced depression as a profound crisis of identity. Moreover, many patients seemed to characterize their depression as though it were an external, malevolent entity that actively works against them. Key phrases emerging from the dialogues included:

“I’m not myself.”

“The me with depression is not who I truly am.”

“I knew it was back.”

“It consumes me.”

We set out to explore these themes of identity and external agency with a series of in-home ethnographic research engagements. Among other findings, researchers were able to validate that an identity crisis and the sense of an external agent working against the patient were both very much a part of the patient’s personal illness narrative.

But that was not all. In fact, the ethnographic research engagements brought out aspects of the identity crisis that had not been as clear in the exam room dialogues. Interviewing the patients in their homes suggested a very strong connection between the identity crisis and the critical relationships in the patient’s life.

These new insights helped inform the questionnaire developed for follow-up telephone interviews with the patients who participated in the in-home ethnographic research. In response to a question of whether she had ever contemplated stopping an anti-depressant she had been taking, the same patient said no, she had not.

“I really see no sense if I’m feeling better. I’m a better mother. I’m a better wife. I’m a better friend, a better daughter. So, it’s pretty much working so far.”

From that TDI came the deeper insight that not only is depression experienced as a profound identity crisis but also that depression relief is experienced as a palpable improvement in the key relationships within the patient’s life. Within the depression patient’s journey, successful treatment of the illness is framed not just in terms of identity but also in terms of relationships. These key insights enabled the pharmaceutical brand to begin communicating in an entirely new – and an entirely more meaningful – way with both patients and physicians.

The hopes, fears and feelings

Understanding the 360-degree perspective of the patient journey is critical in communicating effectively with both the patients and physicians. A multi-method approach reveals not only the hopes, fears and feelings expressed during in-office dialogues but also extends to at-home conversations patients have with loved ones and caregivers. Combining insights from the different approaches and different sources reveals a depth of understanding of a patient’s feelings and experiences that allow you, as a brand team, to directly connect with your consumer.

As a brand team you can begin to communicate with patients and caregivers with an emotional intimacy, creating a deeper connection and more visceral response than if talking in a language of scientific specificity. As an organization you are also able to provide physicians with the information and tools they need to help support a patient; not only in the office but throughout the whole patient experience. By incorporating insights from 360-degree market research program into your brand strategy you can move beyond providing just a solution to an illness and create a fulfilling experience that supports physicians and patients throughout the entire health care journey.