 |
By Noah M. Pines, Executive Vice President, GfK V2
Patient case studies often are employed within the context of physician-oriented promotional materials to simplify involved and frequently complex clinical data into practical, day-to-day situations that are relevant to a physician’s medical practice.
Patient case studies have a variety of applications, ranging from exemplifying appropriate utilization, underscoring a particular clinical trial result, even expanding the potential indication or spectrum of applicability for the medication in question. They can be thought provoking to physicians, spurring reconsideration of a drug’s role and/or where it fits in. Further, viewing a patient’s face can contribute a touch of humanity, even warmth to promotional materials that are often saturated with clinical messages and scientific data.
There are, however, important considerations that span from the inception of these patient case studies to their presentation to physicians in the office. As noted above, patient case studies can be a highly effective asset in driving home the brand message – or a liability that may hobble the validity of the entire marketing piece. This article is intended to provide guidance on how best to conceive and present patient profiles, particularly within the context of professional detailing materials, with a focus on how marketing research techniques can be used in crafting effective case studies.
A patient case study is essentially a brief delineation of a specific case report that features clinical and often nonclinical information relevant to a provider’s rendering a treatment decision. Patient case studies frequently appear in professional sales brochures, on product- or disease-oriented Internet Web sites, and other pharmaceutical promotional pieces aimed at physicians (as well as materials targeting patients, managed care decision makers, nurses and other customer types). These case studies may be either embedded in the visual aid brochure itself or be separate sheets nested in a sleeve at the back of the brochure.
Patient case studies usually are accompanied by a photograph of that patient, either a close-up of his or her face to a full body layout. The determination of whether it is a face or full body image may vary depending on the therapeutic area. For instance, psychiatric medications often involve just a close-up of a younger person’s face, while a medication for arthritis may feature a full body photograph to demonstrate walking or other activity.
The individual pictured in these case studies may either be an actor, or increasingly, a real patient (this fact often is noted next to the case study). The patient’s first name often is featured, again, to personalize the situation. Patients who have used a drug often give permission to lend their visage (and their story) to promotional materials, especially when that drug has saved or dramatically improved their lives. Novartis, for example, has used this approach in promoting its oncology medications.
The development of patient case studies usually is spearheaded by the advertising agency in conjunction with medical experts and a marketing research vendor. Often, case studies are actual patients, who have been supplied by physicians and either suitably masked (to protect their identity) or abstracted from actual patient charts. Patient case studies must reflect the types of subjects that were included in the registrational trial data accompanying the product in question, and thus should correspond to the clinical study inclusion criteria – indeed, the FDA demands that they do.
Marketing research often is employed to select among alternative case studies based upon such parameters as clinical relevance, believability and influence on the physicians’ motivation to prescribe the medication in question (or to adopt some specific behavioral objective). Within the context of an individual interview or a focus group, respondents (physicians) would be instructed to rate/rank alternative patient case profiles according to these parameters, and to discuss why certain cases drive, or do not drive, the appeal of a product. Qualitative, open-ended feedback can be valuable in both discovering the relevant decision-making factors that would lend credibility to a case study as well as in exploring realistic scenarios that will drive a specific behavior.
Based on our experience, physicians generally appreciate patient case studies as a way for themselves to make sense of often complicated clinical trial results, especially from the perspective of appropriate patient selection. Additionally, case studies can be thought provoking, affording the opportunity for dialogue with the sales representative or medical science liaison.
Based on our extensive experience conducting marketing research to evaluate patient case studies within the context of physician-oriented promotional brochures, the following are some key success factors involved in creating effective patient case studies:
Medical Authenticity
While it is not always necessary to provide a masked case study of an actual, true patient, it is imperative that the case study represent a plausible set of patient attributes that would realistically present in the physician’s practice. A case study can lose its credibility if, say, the patient is claimed to be taking medications which are contraindicated. The picture also needs to correspond to the profile based upon age and specified morbidity. For example, manufacturers of HIV medications were criticized in the early days of highly active antiretroviral therapy (HAART) for portraying patients who appeared to be too healthy and too happy given the devastating effects of the disease.
Additionally, it is crucial to provide the salient parameters, i.e., clinical symptoms, biochemical, social characteristics or otherwise, that physicians would need to render a clinical decision about a particular patient. Let us consider an example within the field of HIV medicine. We know that physicians make decisions to prescribe certain antiretroviral medication combinations not only based upon serologic and virologic measures (e.g., CD4 count, viral count, etc.) but also based upon the patient’s social circumstances, potential to adhere to the regimen and even the availability of a support network. Not offering a full range of key decision-making factors can subvert the physician’s ability to respond intelligibly to the case study, undermining credibility. Again, marketing research studies can be utilized to evaluate the essential parameters required to decide the course of treatment for a particular patient.
Presenting a Singular Message
Each case study is essentially an abbreviated vignette or short story about a particular patient. As noted earlier, patient profiles serve to help physicians make sense of complex, abstract data, bringing it home and making it relevant to their day-to-day medical practices. Given the context in which these case studies are likely to be presented, especially the fact that physicians only will devote a brief period of attention to interpreting the main point, a case study needs to be singularly focused on one key point. For example, if the point of presenting the case study is to highlight a drug’s efficacy in patients with a specific comorbidity, this comorbidity should be the main focus of the case.
Moreover, more complex or controversial case studies often cannot be credibly delivered by sales representatives and are better suited to other venues, such as physician-led advisory board panels. Sales representatives may not have the technical expertise to credibly address the full range of questions that may arise out of the discussion of a complex case. Indeed, some physicians – particularly specialists – may not even find the presentation of complex case studies by sales representatives to be credible and would demand they be presented by a clinically trained medical science liaison.
Let’s consider a hypothetical example that was effective in driving a message to change behavior. A company marketing a medication for hepatitis C virus (HCV) was utilizing a patient case study to illustrate the fact that certain individuals infected with HCV tend to progress more rapidly, and that it is difficult to predict which ones will progress more rapidly without serial histologic data. Such data may provide the rationale to expand the scope of which patients are considered for treatment in the near term.
The company’s brochure showed the profile of a patient who had, within three years, progressed from a METAVIR score of 0-1 (which does not necessarily warrant treatment) to a METAVIR score of 2 (where treatment becomes indicated within the context of other factors). Due to the typically slowly progressive nature of this viral liver disease, this is a trend of concern. While other factors were presented, including the patient’s age, family situation, concomitant illnesses, this case effectively illustrated the fact that rapidly progressing patients may be lurking within a population, creating an imperative among physicians to either reevaluate all patients with a lower METAVIR score or expand their definition of which patients warrant treatment.
Proper Sequencing of Case Study Presentation
The order or sequence in which multiple case studies are presented can make them more or less impactful. For example, if the goal is to encourage physicians to expand their prescribing of a medication to a new type of patient, the following approach might be effective. The physician is first presented with a case study that reflects his or her current, natural usage of the medication. This gives the physician a sense of satisfaction in reinforcing current usage of the medication. Next, the physician is shown some data, followed by the presentation of an "aspirational" patient case study.
The idea here being that “Doctor, we can agree that you would use Product X in (obvious patient), but did you know that you could use it in (aspirational patient)?" Thus, this sequenced approach can help move the physician from his or her comfort zone to an expanded array of patient types or clinical circumstances.
Balancing the Obvious and the Controversial
One of the most difficult aspects in designing a patient case study is making it obvious enough to serve as an illustrative case for using the product in question (and not steering the physician’s thinking toward another option). Thus, marketing research processes are crucial in determining the exact, optimal composite of characteristics that would naturally lead a physician toward prescribing the product in question.
Case studies often are challenging for sales representatives to present credibly; indeed, some physicians bristle when presented a medical case study, particularly one that is potentially controversial, by an individual who is not clinically trained, as noted earlier. The following are some guidelines on how to effectively present case studies to physicians:
Let the Physician Decide
As opposed to declaring that a particular patient would be an appropriate candidate for the product in question, one way of approaching a case study is to let the physician make the decision. For example, to say “Doctor, given the data that I have presented, what do you think about this type of patient as a candidate for our medication?” Again, this serves a dual purpose of empowering the physician and involving him or her with the product by allowing the physician to interact with a hypothetical patient case study.
And where the case study is somewhat complex, this precludes the representative from having to debate with the physician (and thus potentially lose credibility).
Present the Data First
One key mistake that we often witness in developing and testing visual aids is where the patient case study is out of sequence with the study data that the case study is meant to illustrate. Simply, a case study presented without the context of data, especially when this case study represents an aspirational situation, may be rejected as not credible where the data are not presented first.
As we have shown, patient case studies represent an efficient modality by which clinical trial results can be incorporated meaningfully into the day-to-day practice decisions that physicians make for individual patients. However, key factors drive the manner in which they are received by customers – authenticity, simplicity and proper sequencing being key determinants of success. The messenger also matters. Complex cases should be presented by MSLs or within the context of advisory boards, not by sales representatives.
Also, by offering the physician the chance to quickly make the right decision, as opposed to force-feeding, sales representatives can score points for credibility as well as get the physicians’ thinking oriented toward how the product will fit into his or her practice.
|
|
Usage of Patient Case Studies in Promotional Materials
