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Eliciting Societal Views on the Value of Life-Extending Treatments Using Q Methodology

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Care at the End of Life

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Abstract

Publicly funded healthcare systems operating with fixed budgets must incorporate rationing mechanisms of some sort in order to set priorities. Efficiency, which might be defined broadly in health terms as maximising health benefits with respect to cost, is a key consideration in setting priorities. However, efficiency is not the only consideration, and members of society may value other issues in relation to the distribution of resources to different groups of beneficiaries. Life-extending treatments for people with terminal illnesses, which are non-curative by definition and often produce relatively small health gains in relation to their costs, are a prime example of technologies that might not satisfy usual cost-effectiveness thresholds. It is generally accepted that the views and values of members of the public, as taxpayers and potential patients, are relevant in determining priorities in the provision of publicly funded healthcare. This chapter introduces Q methodology as a structured approach to eliciting and describing societal values, combining qualitative and quantitative techniques to study subjectivity, with reference to research carried out relating to people at the end of their lives.

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Notes

  1. 1.

    Q sorts can also be conducted online and usually online procedures are designed to mimic, as closely as possible, the manual sorting process, given the restrictions of screen size and so on. Many Q methodologists would still prefer face-to-face Q sort interviews, if it is practical to do so, for several reasons including the ability of respondents to view all materials together (a completed Q sort can be difficult to present legibly on a computer screen) and the opportunity for interaction and explanation afforded by in-person Q sort interviews.

  2. 2.

    It is worth noting that the process of interpretation tends to be iterative with factor extraction and rotation, and several attempts at interpretation of different solutions will be required prior to settling on a satisfactory solution.

  3. 3.

    This purposive sample was supplemented by a larger general population sample of 250 respondents who also completed the Q sort, but analysis did not generate any additional perspectives.

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Authors and Affiliations

  1. Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK

    Rohan Deogaonkar, Rachel Baker, Helen Mason, Neil McHugh & Marissa Collins

Authors
  1. Rohan Deogaonkar
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  2. Rachel Baker
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  3. Helen Mason
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  4. Neil McHugh
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  5. Marissa Collins
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Correspondence to Rachel Baker .

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Editors and Affiliations

  1. UCL Comprehensive Clinical Trials Unit, Principal Research Associate, London, United Kingdom

    Jeff Round

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Deogaonkar, R., Baker, R., Mason, H., McHugh, N., Collins, M. (2016). Eliciting Societal Views on the Value of Life-Extending Treatments Using Q Methodology. In: Round, J. (eds) Care at the End of Life. Adis, Cham. https://doi.org/10.1007/978-3-319-28267-1_10

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