Hearing from a variety of healthcare stakeholders is crucial to getting a full picture of the current market. One approach to this kind of well-rounded research is to listen to naturally occurring HCP-patient conversations. Being a fly on the wall certainly has its advantages; you’re able to (in theory) unobtrusively observe how these two groups move through a range of topics in an authentic setting. But true dialogue studies have their challenges. Below are some of the concerns we’ve heard from customers about ‘traditional’ approaches to HCP-patient dialogue research:

Studies are too time-consuming and subsequently cost too much.

 For one, in-office dialogue studies can be time-consuming to pursue, requiring analysts to sift through hours of data for only a few snippets of relevant conversation.

The data quality of the recorded conversations is unreliable and hard to generalize. 

Additionally, natural dialogue may not, well, naturally cover all points of interest for the client team. Subscribing to the quirks and whims of a real HCP-patient interaction means that vital questions may go unanswered. On top of that, there is no way to control the unique characteristics of every conversational nuance, so trends become harder to identify with certainty.

The ‘why’ behind what is said is unclear. 

Lastly, while hearing conversations unfold can be intriguing, it is often unclear as to what each stakeholder is thinking and what is actually driving key decisions. This is especially true on the patient front, as they can be notoriously quiet during in-office visits.

" solution enables clients to access relevant dialogue data more quickly and systematically than traditional methods—as well as understand the ‘why’ behind the patterns. In this methodology, our team of trained linguists intentionally designs two phases of voice research to simulate typical HCP-patient interactions, with authentic patient audio clips from Phase 1 serving as stimuli for HCPs in Phase 2 and vice versa. Through this approach, we uncover key moments that matter regarding the condition in question, its symptoms, and treatment options. From the specific lexicons HCPs and patients use when discussing symptoms to the larger communicative dynamics at play in a treatment discussion, we identify what is working well in the current conversation and where conversations can be optimized. Such an approach facilitates a broad understanding of the current landscape and provides clients with strategic, actionable insights informed by our experience across the spectrum of market research.

A Case Study: "Constructed Communication" in Action

inVibe recently partnered with a mid-sized pharmaceutical company in the dermatologic space that wished to understand how patients and HCPs communicated and felt about a particular condition. Specifically, our client hoped to a) uncover the natural language HCPs and patients use to talk about symptoms and treatments, and b) identify effective communication strategies and current misunderstandings between parties.

" solution: a multi-phase voice-powered research study. In Phase 1, inVibe screened and recruited 10 patients and 10 HCPs with relevant dermatological experience to participate in an automated phone interview, responding to questions simply by speaking. The most representative and thought-provoking voices captured in Phase 1 of research served as stimuli for Phase 2, where 20 patients reacted to the voices of real HCPs and 35 HCPs listened to the voices of real patients to create an interactive communicative environment. Then, we got to work analyzing the HCP and patient perspectives and synthesizing them into one dynamic report.

Overall, this approach yielded a rich data set and a plethora of insights into the diagnosis journey, severity and quality of life issues, the broad treatment landscape, and the specific class of treatments our client’s product belongs to. However, we identified three particularly critical gaps in HCP-patient communication with clearly defined paths for resolution.

 "The other thing that I'd like to share is my own experience where I had my first flare-up as a minor, prepubescent, and I was significantly thinner, was within the range of weight I should have been for my height, was not obese at all, was not smoking or partaking any poor behavior. So, what are the other factors that contribute to this disease? Because age, obesity, and smoking are not it." 

First of all, HCPs often approach initial diagnosis conversations by connecting patients’ bothersome symptoms to lifestyle factors like smoking and obesity. Though HCPs may perceive this discussion as purely informative and unproblematic, patients interpret this association as blame for ‘causing’ their condition. Consequently, patients either feel ashamed and are disinterested in pursuing further treatment or vocally disagree with this assertion and defend themselves. Either way, this sense of blame can strain HCP-patient relationships from the start. To remedy this fraught exchange, we recommended that HCPs forge a strong and trusting relationship with patients by reassuring them that they are not to blame for their symptoms, which may lead to better diagnosis discussions.

 "[…] If you're going to take the time to do the step-to-step approach, that means things aren't getting solved, so you're adding another layer to another layer to another layer. My advice would be skip the topical because they don't ever work for anybody. Go straight to the antibioticsand then, if those don't work, see a surgeon, cut it out." 

Secondly, patients and HCPs also have distinct perceptions of the standard treatment approach. HCPs regularly employ the stepwise method, starting patients off with topicals and progressing to ‘stronger’ options. However, patients express frustration over this pathway; they perceive starting ‘slow’ as a waste of time that only acts as a barrier to getting efficacious treatments in a timely manner. We advised the client to activate patients to vocalize their first-choice therapy and detail their symptom experience early on in treatment discussions, as patient preference and symptom severity may prompt HCPs to prescribe later-line therapies sooner. 

 "[…] there's a lot of side effects that go along with it. He said he's not too concerned with it, but I am because I wouldn't want to deal with those […] I'm open to just trying things, different things out, but I just wouldn't want to risk the different side effects and long-term symptoms and things like that." 

Finally, we heard skepticism from patients about the safety of the client’s drug class. Despite HCPs brushing over side effect discussions as something they’re "not too concerned" about, patients are certainly worried about what short- and long-term effects that kind of treatment might have on them. For patients, safety is a paramount factor when considering whether to try a treatment, so HCP nonchalance about it is frustratingly vague rather than reassuring. We suggested HCPs need to simply and transparently establish the client’s new treatment safety profile to mitigate patient concerns. Additionally, to garner more patient buy-in despite any hesitations about side effects, HCPs could frame the new treatment as a preventative and convenient option that keeps patients’ symptoms at a minimum on a schedule that works for them.

" approach is a quick and targeted way to identify communication successes and missteps between stakeholder groups—as well as the ‘why’ behind them. Our intentionally designed prompts paired with stimulating soundbytes evoke robust, pertinent discussion that illuminates crucial gaps in the conversation. With our insights, our dermatologic client was able to design appropriate, well-thought-out materials, including a conversational reference guide. Yet this methodology is broadly applicable. From rheumatology to neurology, from pipeline to approved treatments, we can make more impactful recommendations to optimizeconversation and improve product perceptions.

How inVibe Identifies and Addresses HCP-Patient Misalignment 

Mind the (Communication) Gap

In 2022, the FDA began developing a series of four methodological patient-focused drug development (PFDD) guidance documents to address how healthcare stakeholders can incorporate the patient voice into the drug development process. These materials indicate that the need to listen to patients is a clear priority for the FDA, and soon, it may be more than just a “nice-to-have”; we are likely not far off from patient input in the clinical trial process being mandated.

The second of these guidance documents, “

Patient-Focused Drug Development: Methods to Identify What is Important to Patients

,” highlights the benefits and drawbacks of various qualitative, quantitative, and mixed methods research types. In response to this guidance, we have shared how inVibe’s 

asynchronous, anonymous Listening Platform

efficiency and scalability of quantitative research

. Yet, when we pair our voice response design with our quantitative capabilities, we open up a new world of nuanced 

When considered separately, quantitative and qualitative research each have their own strengths. Quantitative research is scalable, quick, and cost-effective: a perfect option for hearing from a large sample in a short time. While qualitative research typically involves a smaller sample, it provides unparalleled depth and detail behind respondent thoughts, feelings, and behaviors. Depending on objectives, there are plenty of reasons to use one methodology over another.

But if quantitative and qualitative are great on their own, they’re even better together. Combining these two approaches enables trial sponsors and CROs to get to the “why” behind the “what.” Through quantitative surveys, patients share 

 their thoughts are, often via closed-ended rating, visual scale, ranking, and yes/no questions. Qualitative research subsequently elicits 

these quantitative answers were given, offering opportunity for elaboration in an open-ended context. These complementary methods are sure to generate a robust, multifaceted data set regardless of context, but a combined approach specifically in the clinical setting ensures the industry is developing products and services that truly address the needs of patients.

The inVibe approach to mixed methods research

At inVibe, we strive to blend qualitative and quantitative mediums at every step of the process to ensure one story is told seamlessly. Let’s look at two key elements of a mixed methods project — design and analysis — to see just how integrated our approach is.

The inVibe research arm is one unit. While individuals in the department may have more experience in qualitative or quantitative research, we are not siloed by our expertise. This means that for a mixed methods project, we compile one team that embodies both our quantitative and qualitative capabilities. This team works together throughout the entire project lifecycle, starting with research design. All members first collaborate on the quantitative portion of the survey, designing a comprehensive set of questions that broadly elicits perceptions and behaviors across a range of topics. We then turn our sights to the qualitative portion, where we craft open-ended voice response prompts that probe on select aspects of the quantitative portion. By the end of this design phase, such a cooperative approach yields a unified yet multi-dimensional survey covering both general and specific areas of interest.

 Once all of the responses are in, we look at all of the data holistically. Since we intentionally devised complementary quantitative and qualitative questions in the design phase, we need to analyze them in tandem. Turning first to the quantitative findings, we gather the bird’s-eye view of 

 respondents are thinking. Moving on to the corresponding qualitative findings, we fill in the details of 

that is the case. The seemingly disparate pieces of the puzzle fit together seamlessly, providing breadth and depth around each theme.

Analyzing qualitative data can be messy, but the inVibe methodology addresses these challenges in a structured, standardized, and scientific manner. By obtaining 

 for each individual respondent and asking all respondents the exact same questions in the exact same way through pre-recorded prompts, inVibe is able to structure what is traditionally unstructured qualitative data. This scientific data collection method is what makes it possible for us to analyze both acoustically through machine learning and linguistically through our expert linguistic analysts. The combination of the methodology with the technology then allows our team to identify similarities, differences, and trends, and roll up larger sample sets to reveal speech emotions and deep insights.

In short, we believe that merging quantitative and qualitative research into a unified undertaking through our simple, systematic, and scalable methodology is the best of both worlds for clinical research. Cohesive design, analysis, and reporting unlocks levels of knowledge that is greater than the sum of its quantitative and qualitative parts. By understanding both the “what” and the “why” behind patient responses, we can make more impactful recommendations to ensure patient-focused drug development in your study and ultimately bring better and more personalized medicines for patients.

Using inVibe's mixed methods research to gain deeper insights

Listening Deeply: How inVibe gets to bottom of what patients are thinking

Clinical trials are important – vitally so. They are the science that needs to get done to help make the world a healthier place. However, as vital as clinical trials are, there are major challenges that every study has to overcome in order to be successful. Even leaving aside the uncertainty of whether a drug hits its endpoints, simply finding people to participate can be quite difficult, and retaining them can be even harder, especially if their needs are not being met.

This is where inVibe’s exclusive voice response offering comes into play and where listening can be truly crucial to designing a trial that works. How can you best make participating in a trial more straightforward for patients? How does simply listening to the patient at all stages of a clinical trial impact recruitment and retention? How can you anticipate what parts of a trial process patients will find most burdensome? Simply ask a few, and listen to what they have to say. This process of Co-Creation can lead to trials that are truly patient-centric, reducing the common, yet burdensome challenges they face, and helping to bring the drug or treatment to market. The trick, of course, is knowing how to listen.

Recently inVibe worked with a mid-sized pharmaceutical company developing a treatment for Parkinson’s Disease. Our client wished to understand how participants react to and interpret the Informed Consent Form (ICF), particularly regarding the Study Purpose, Participant Responsibilities, and Potential Risks & Benefits. This is a valid concern – if a patient is not quite sure of what the goal of a trial is, what is expected of them, and what the potential upside and downsides to participating are, they are unlikely to enroll. The task was fairly straightforward: have Parkinson’s Disease patients and caregivers evaluate the ICF, understand what was confusing or potentially detrimental to future recruitment, and recommend potential solutions.

To accomplish this goal, inVibe leveraged our voice response methodology to listen both effectively and efficiently. To listen effectively, we created a set of eight automated voice prompts for patients and caregivers to respond to. This voice response design created a structure that allowed respondents to speak freely, while simultaneously setting boundaries on the topics being discussed. To listen efficiently, we fielded this study with 17 patients and 4 caregivers in 72 hours, then we got to work on analysis.

“I thought the document was very thorough, and it wasn't overburdening. So, in other words, I felt like I could read the entire thing without getting overloaded with information. But it was very clear. The risks were present. The amount of time it would consume was pretty evident.”

Overall, the responses were positive. Respondents were generally able to explain the purpose of the clinical trial in their own words, and they found the decentralized design of the trial more compelling and less burdensome than a more traditional trial would be. 

, there were some important nuanced points that required further exploration.

First, some respondents were uncertain about whether they would be eligible for the trial. As anyone who has encountered this uncertainty in trial recruitment can attest, if a patient is not sure about whether attempting to enroll will be a waste of their time, they likely will not bother and self-select out of the process. We emphasized the need for absolute clarity on eligibility requirements to prevent potential harm to recruitment.

Second, we had some respondents raise the issue of how to manage any potential side effects of the trial drug. Again, this uncertainty can cause issues both with recruitment and with retention, as a patient encounters a problem, is unsure how to address it, and chooses to discontinue. Again, we proposed a straightforward solution: provide more information on AE management at the outset, as well as link to resources that participants can bookmark and refer back to when needed.

“I guess that the biggest potential risk and potential dealbreaker would be the spinal taps, of course. I understand that they are painful and risky, but you also have to consider that there are potential benefits like getting to know your disease better, and that should also be highlighted.”

Last, and perhaps most importantly, respondents flagged up the risks of treatment. Here the issue was slightly different; participants understood the risks, but not necessarily the reasoning behind them. For example, the trial would involve multiple lumbar punctures, which the informed consent explains clearly. However, the ‘why’ behind these punctures was left unexplained, which led respondents to call them out as a potential barrier to entry. While patients will implicitly understand that these sorts of procedures are part of the trial, we advocated for a ‘more is more’ approach to explaining the punctures as part of a diagnostic process and an evaluation of the treatment. A lumbar puncture is never going to be pleasant, but making sure that a patient knows precisely why it is happening and how it can help can make the prospect less discouraging. After listening to patients describe this discomfort, we recommended that the trial developer explain this procedure and the reasoning behind it as clearly as possible to get participants on board.

While patients implicitly understand that these sorts of procedures are part of the trial, inVibe advocated for a ‘more is more’ approach to explaining the punctures as part of a diagnostic process and an evaluation of the treatment. A lumbar puncture is never going to be pleasant, however making sure that a patient knows precisely why it is happening and how it can help can make the prospect less discouraging. After listening to respondents describe this discomfort, we recommended further explaining this procedure and the reasoning behind it as clearly as possible to get participants on board. What they needed to improve their odds of a successful trial was to listen, and at inVibe, that's what we do. 

How to Develop a Patient-Centric Clinical Trial with inVibe

Another Home for Listening: Leveraging Real Patient and Caregiver Voices

The importance of storytelling and making sure patient voices are heard.

Here at inVibe we tend to obsess about the importance of storytelling, and we’re particularly passionate about making sure patient voices are heard.

As inVibe’s Director of Research Kathryn Ticknor noted in 

PharmaVOICE’s 2nd annual Patient Perspectives edition

, “patient stories may be among the most powerful tools for fostering patient-centricity — as well as the most easily misunderstood. In a world where big data is king, we can be quick to dismiss storytelling under the label of ‘anecdotal evidence’ and ‘small sample sizes.’ Yet, as human beings, we are hardwired to respond to narratives at a deeper emotional level than we ever could to a series of numbers.”

And what exactly is behind that hardwiring? What makes stories so sticky?

The power of storytelling comes from its inherently 

 nature. In healthcare, this is in stark contrast to the 

 dynamics of the intake form, exam room, or satisfaction survey. Storytelling is rooted in a uniquely human format that encourages patients and caregivers who may not be fluent in “medicalese” to participate and share more fully and authentically than they otherwise might.

Stories also stick because our brain is built to learn by 

. Humans process emotional stimuli first and foremost through the auditory system. As a result, we react to the 

 faster and more empathetically than we do to written text. Without these cues, the challenges of decoding and correctly understanding natural language multiply — as do the potential traps for brand decision-making. As researchers and marketers strive to be more patient-centric, it is vitally important to move beyond just hearing 

 it is said.In many ways, listening becomes the “System 1” of emotional analytics — helping us to quickly understand a speaker’s intention, mood, and attitude at a deeply human level. By taking time to listen to patient stories, we move from “anecdotal evidence” to a framework for empathy and understanding.

 to find out how inVibe can help you listen better.

Story originally published April 8, 2019.

What makes stories stick?

Thanks for reading!

Mind the (Communication) Gap

Listening Deeply: How inVibe gets to bottom of what patients are thinking

Another Home for Listening: Leveraging Real Patient and Caregiver Voices

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