In-the-moment research reveals hidden physician prescribing behaviors

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By Megan Long, senior analyst at SKIM


Access to information at the moment of decision making is continuously altering the consumer decision pathway and the ubiquity of personal technology is accelerating these changes. In 2014, 57 percent of Americans owned a smartphone, a number which is expected to grow exponentially in the coming years. With the growth of smartphone use, respondents will soon be unwilling to take surveys lasting longer than five minutes and they will less often take those surveys on screens larger than 5 inches. Yet many companies and market researchers are still playing catch up. The consequence of this new “5×5” reality requires a completely new approach to connecting with consumers through mobile research.

Conducting research with mobile devices is not a new concept in market research. However, much of the research currently conducted using mobile devices simply applies traditional methodologies to mobile surveys, modified for a smaller screen. A true in-the-moment mobile methodology leverages the penetration of mobile devices in everyday life to gain deeper insights into the changing pathways to decision. In-the-moment mobile research can be used to understand what customers are thinking at the moment they make their decision, an area in which traditional market research methods fall short.


How and why traditional interviews fall short

For years, market researchers have searched for a balance between speed versus depth of insights, qualitative versus quantitative, and rational versus emotional. Traditional qualitative interviews are expensive and time consuming, and physicians and patients are often difficult to recruit for in-person interviews. Quantitative methods can be faster, yet the emotional factors behind decision making are lost over time, replaced by rationalization and generalization of treatment decisions. In-the-moment research provides an innovative method for seamlessly melding qualitative and quantitative, emotional and rational. By connecting with physicians directly after patient contact, the researcher is able to receive patient-specific insights that explore both the emotional and rational components of treatment decision making — and better guide strategic brand decisions.

There are situations, particularly when both emotional and rational factors are at play, in which mobile research has the potential to uncover insights that traditional methods could overlook. For example, when a pharmaceutical company wanted to understand why physicians were prescribing a competitor’s drug over their own even though the products were largely similar in safety and efficacy, they first turned to traditional research methods. A qualitative chart audit was performed at a central location, in order to understand the drivers behind prescribing each product. Physicians were asked to discuss the characteristics of a patient that received their product, Product A, vs. a competitor product, Product B. They found that the patient profiles for each treatment were largely similar, and they could not identify any unique characteristics in either patient group that would lead the physicians to prescribe different treatments.

Still unsure of the drivers behind prescribing either product, the pharmaceutical company followed this research with a traditional online quantitative survey, which asked physicians brand association questions to determine if the perceptions of each drug were leading to these prescribing behaviors. Again, they did not find any significant differences in the perception of either drug. Two studies later, they were still unable to answer their key business question to understand the drivers behind prescribing, which were key inputs into strategic marketing and business decisions.  
Get closer to the moment of decision

The traditional methods that had been used thus far must have been missing something, but what? A chart audit measures decision making hours, days, or even weeks after the decision has been made. Perhaps there were emotional factors such as patient condition or patient preference that were lost over time and replaced by hard clinical factors such as comorbidities, side effects, and progression. In order to close the time gap and get as close as possible to the moment of the decision, an in-the-moment mobile research project was deployed. By using in-the-moment research, researchers could better understand the why behind physicians’ prescribing decisions.

In order to close the time gap between the prescribing decision and the collection of data, physicians were asked to fill out each patient record immediately after the patient consultation using a simple, easy-to-use mobile app. This method puts researchers as close to the prescribing decision as possible. The survey was designed to take no longer than 5 minutes of the physicians’ time and consisted of two parts: a 3-minute quantitative section of brief close-ended questions revolving around the patient’s history and characteristics (such as treatment history, progression, and comorbidities) and a 2-minute qualitative voice memo recorded by the physician in which they were prompted to describe which drugs were in the consideration set, which drug was ultimately chosen and, most importantly, why this drug was chosen. The survey needed to be simple and short enough for the physician to complete between patient consultations in order to mitigate the risk that they would either drop out of the study or complete the survey at a later time, undoing the benefits of in-the-moment research.

This particular research project was conducted among 50 oncologists in the United States and 65 oncologists in Germany, the United Kingdom, Italy, and France. The survey asked each physician to complete the patient record survey after seeing a qualifying patient, which was defined based on the diagnosis and treatment prescribed. Each physician was asked to complete the survey for three to five qualifying patients throughout the study. There were 254 patient records collected from the physicians in the US and 262 in the EU.
Researchers used this data to perform several analyses blending the qualitative and quantitative data. Each patient case was segmented by several key metrics such as disease progression, comorbidities, and drug prescribed. The use of segments defined from the quantitative data allowed researchers to identify several differences in reasons for prescribing in the qualitative data, including both logical and emotional drivers – something that the traditional survey methods failed to capture.

Historically, in this indication, physicians have been the driving force behind the treatment prescribed to the patient, basing their decisions on hard clinical facts and indications. This research revealed, however, that patients were proactively suggesting treatments more often than expected. For example, patients that were more advanced tended to refuse chemotherapy treatment, opting for an alternative treatment instead. There was often an emotional aspect to their refusal. Many felt they had reached the end of the line and could no longer handle a harsh treatment with many side effects. Also, in many cases, oncologists would suggest several treatment options and then discuss the pros and cons of each, ultimately deferring to the patient on which treatment to choose. This consultative approach had a significant impact on the pharmaceutical company’s drug, Product A. Often Product A was not included in the consideration set, thereby excluding it from the conversation. When Product A was discussed as an option, there was a very high likelihood that it would be prescribed. These interactions were largely unknown to the maker of Product A and indicated that they could alter their marketing efforts to capitalize on this dynamic.

In-the-moment insight leads to a new market approach

As a result of this research, the makers of Product A took several steps to change their targeting for this product. The role that the patient plays in the treatment decision suggested that better educating the patient could increase the likelihood of being part of the consideration set. Accordingly, they increased materials and programs geared toward patients, rather than focusing only on clinical data such as efficacy and safety. The company also updated their product messaging to clearly outline the target patient for the drug, as well as the key benefits for those patients. By providing clarity to the appropriate target patient population, the pharmaceutical company increased the likelihood that Product A would be in the consideration set for the targeted patients.

Only by putting researchers “in-the-moment” with physicians and patients could one begin to understand that a less clinical, patient-centered approach to prescribing for this specific indication and drug could be more effective. In-the-moment mobile research presents tremendous opportunities for understanding market potential, segmentation, treatment pathways, and more. By minimizing post-rationalization of responses and getting closer to the point of the decision, researchers can deliver better answers to challenging questions like this one.