Integrating Patients’ Perspectives, Context, and Implementation in the Assessment of Complex Health Technologies.

Background: The rise in chronic diseases in ageing populations has led to the development of increasingly complex technologies. Current Health technology assessment (HTA) methods do not sufficiently take into account the diversity in patient characteristics and patient preferences, as well as context and implementation issues. A strategy is needed to integrate all these aspects into a comprehensive assessment. Objectives: This EU-funded project aims at developing concepts and methods for a comprehensive, patient–centered, and integrated assessment of complex technologies. Methods: Palliative care has been chosen as a case study as it is a highly complex health technology that deals with heterogeneous patients’ conditions, needs and objectives. Stakeholder advisory panels (SAPs) were established in 6 European countries to ensure public and patient involvement (PPI) that informs the scope, research questions and outcomes. Logic models and a framework are used to conceptualize the intervention in its context. Literature searches, quantitative and qualitative methods are employed to assess effectiveness as well as ethical, socio-cultural, economic, and legal issues. Results: Interim results suggest SAPs are instrumental for including the patients’ perspective in the assessment of complex technologies. Logic models have rarely been used in HTA but are helpful in understanding sources of complexity in the intervention and its implementation, in (un)desired outcomes and in the interactions between intervention and context. The integration of patients’ perspectives with medical, economic, ethical, socio-cultural, and legal issues needs to be undertaken from the outset of the HTA, not at the end. Conclusions: For the assessment of complex technologies HTA-methodology needs to be adapted at all stages. The patients’ perspective can be obtained through stakeholder panels. An integrated perspective will improve the relevance of the assessment for all stakeholders, including patients.