Earlier this month, the Arthritis Foundation and Takeda Pharmaceuticals U.S.A., Inc. launched Let’s Speak Gout, a program offering tools to help HCPs and patients get on the same page about gout and make management of the disease a priority. In order to get the insights needed to develop these tools, research was conducted using an innovative bridge group approach.
Patients with gout participated in focus groups to discuss their attitudes about and understanding of the condition as well as their communications with doctors—all while doctors overserved these discussions behind one-way mirrors. Then the script was flipped. A new group of doctors participated in focus groups about how they treat gout, while a new group of gout patients observed their conversations. In both cases, the patients and doctors were separately asked for their perceptions and reactions to suggested words and phrases that would improve communication.
Four key findings were revealed on how to create more effective HCP/patient discussions about gout:
- HCPs and patients do not currently share the same definitions for effective gout treatment. They need to establish common goals for number of flares and for uric acid level, then regularly screen and track progress towards those goals.
- Both patients and HCPs overemphasize the dietary component of gout and often overlook the larger genetic component, leaving patients feeling guilty and potentially less honest in discussions with their doctors.
- Both patients and HCPs focus on treating the short-term pain of gout attacks and do not always address the long-term consequences and potential damage of untreated gout.
- There are specific ways to shift the tone and content of HCP/patient discussions about gout that may yield more effective interactions and better patient outcomes.
PM360 spoke to Thomas Gibbs, Senior Vice President, General Medicine Business Unit, Takeda, about using this research technique, what they learned along the way, and offers advice for other companies who want to try something similar.
PM360: Was this the first time you tried the bridge group approach?
Thomas Gibbs: The whole Let’s Speak Gout focus was on trying to improve the communication between gout patients and their physicians. So, yes, this is the first time that we used the approach, but it was based upon the hypothesis that there was a communication gap. As you would probably suspect, we’re always looking for innovative and unique ways to understand our customers and uncover true patient and physician insights to help shape our strategy. So we really try to derive the appropriate methodology based upon those specific information needs. We used this bridge group research approach to better understand what gout patients really think, feel, and communicate about their condition and its management, and in turn, what physicians who treat gout patients really think, feel, and communicate about the management of their patients.
So were there other methodologies that you considered before deciding to go with this one?
Yes, we considered the traditional focus groups where you’re looking at them separately and then trying to connect the dots. But we thought this would be something where it would be interesting to get the other group’s view of what the patient is saying, for example, for the physician, and what the physician is saying for the patient. What was interesting is that many times when you’re doing research, you’re just hearing what somebody else’s view is, and in this case, there is actually shared learning across the groups. Our methodology also incorporated projective techniques (sentence completion, conversation mapping to identify what patients and physicians would “think, feel, and say” in an ideal gout dialogue, etc.) and observation components that allowed us to identify conversation barriers, communication gaps, and specific words/phrases that would most effectively improve the patient-physician dialogue.
Ultimately, the Let’s Speak Gout program pulled research from a few areas, including what you discovered in the focus group. But was there anything that you revealed during these focus groups that hadn’t been uncovered anywhere else?
Yes, I think so. As I said, through our patient journey work, our hypothesis was that a disconnect existed between both what both gout patients and treating physicians say they communicate, versus what they actually say and do. And in this case, we were right. We found that it’s not just a disconnect between what people say and do, it’s also that the dialogue isn’t happening and both parties are making incorrect assumptions, consequently not raising gout for discussion. We needed to use a unique approach because you can’t explore what people say via traditional research when they may not be talking in the first place.
For example, many physicians said that gout attacks are so painful that they are sure that patients would report these attacks to them, and they assume that there are no gout attacks if the patients aren’t reporting them. But in contrast, many patients said they often do not report the gout attacks to their doctors. They feel ashamed and they feel responsible for the attacks, as they believe they should be doing a better job managing their diet or their lifestyle and adherence to medicine.
So what was interesting is the frequency of gout attacks we found is underreported to physicians, and the physicians didn’t even realize it. And that’s what the Let’s Speak Gout communication tools are intended to do: Address this disconnect and enhance the effectiveness and the ways in which communication between physicians and patients can take place.
For example, the HCP tool that we have includes a section with ways to proactively ask gout patients about the symptoms in a nonjudgmental way that’s not going to make the patients feel slighted or responsible for their gout attacks. To help to diffuse the guilt that the patients have, it includes information to help them better understand that gout is not just a lifestyle disorder, but there are also genetic components to it, as well as their diet, which are risk factors.
On the website, you emphasize the four key findings. Was there anything else that you uncovered that you can share?
Yes, there were a couple of others that, through our lens, were very revealing about the challenges that both physicians and patients face. For example, we saw how important it is for physicians to be able to cultivate a trusting relationship with gout patients so that they can uncover the frequency of flares. Gout is one of those conditions in which patients can be non-compliant with some of the lifestyle modifications that they put in place. And as I mentioned, because of the mindset in which patients feel like they’re responsible for their gout flares, it’s important for patients to feel safe enough with their physicians to tell them what’s really going on, so that the physicians understand the true picture and can best tailor the gout management recommendations for each patient.
What kind of feedback did you get from the participating patients and doctors?
The gout patients who observed the physicians groups, and in turn, the physicians who observed the patient groups, were quite surprised by the other’s context and in some cases patients were concerned and amazed by the misconceptions that they heard. For example: Evaluating uric acid levels. Many patients said that they do not know how uric acid levels are tested and what is considered an acceptable level, and in contrast, many physicians said they always tell their patients that the uric acid levels are evaluated with a blood test and that the goal is to have six milligrams per DL level of uric acid.
Did you find this approach had any unexpected benefits compared to just doing traditional focus groups?
We found this approach to be a very effective tool to truly uncover what was the real unmet need, and in fact, how it was articulated by patients and physicians as it relates to the communication needs. It’s very easy to get to the first level or second level insights, but what we tried to do here was to get to that third, fourth, fifth level insight that really uncovers something that can change the way that we approach communicating with our customers—both physicians and patients. So it is already something that we will consider for other opportunities to leverage this sort of research.
Are there any other specific therapeutic areas you want to look at next or are you just keeping it mind for something further down the road?
Similar to gout, we know that many times it is a challenge to have communication between patients and physicians about depression. This could be another interesting way to approach better understanding of patients who have residual symptoms of depression, and how they communicate that once their mood is taken care of, for example.
Do you have any advice or feedback you would give to other people who might want to consider this approach?
Obviously, the first thing you want to do is look at the business question that you’re trying to answer, and then tailor the research approach based upon that. So consider the question that you want to answer and the need or the insight that you want to generate.
However, I would caution against using a new methodology just because it seems innovative, because research studies should be designed based upon the business needs and objectives. But in this instance, we felt this project was a perfect fit to address our information needs and will be suitable in some other scenarios.
Is there anything you want to add about either the research or the Let’s Speak Gout program?
We’re very excited about the partnership that we have the Arthritis Foundation and we really believe that at Takeda we have to invest in the therapeutic categories that we work in and try to bring patient-centric solutions to help better manage diseases. And we believe that Let’s Speak Gout can be one of those tools to help improve how patients are treated.