Assessing provider (and patient) motivation

Behavioural science provides a roadmap to understanding how HCPs make decisions and what drives prescribing behaviour, but also, more importantly, it gives us strategies that we can apply to disrupt the status quo. The prelaunch, market-shaping phase of a product lifecycle can be exciting, especially if you are preparing the market for a major advancement in the field. You have the opportunity to promote your ground-breaking new drug target, formulation, or device and educate the marketplace on how it will improve patient outcomes by meeting the unmet needs associated with a condition. Compelling messages are crafted to tell a story about how the new treatment will effectively fill these gaps, and prelaunch campaigns are developed to deliver that story to healthcare providers (HCPs) in order to build awareness and knowledge. Is building awareness through education alone enough to change prescribing behaviour? It is unlikely, even when a new treatment may seem like the clear choice. When HCPs make a prescribing decision, they use their clinical training and past experiences (their ‘clinical lens’) to assess the products in their armamentarium versus a new therapy. Here, knowledge (education and awareness) is the key driver. 

But when we consider that HCPs are also seeing and interpreting data through their own ‘behavioural lens’, we realise that information and awareness are not enough to drive them to change their prescribing behaviours. In contrast to the clinical lens, which opens the door to consideration of new ideas, the behavioural lens determines what gets internalised and allows action by processing knowledge in the context of an HCP’s beliefs, perceptions, attitudes, motivations, and skills. How HCPs view a product through their behavioural lens can dictate how open they may be to new data or information and how likely they may be to act on that information. This means that market-shaping efforts need to help data pass through that behavioural lens. What is the impact of barriers, beliefs, and behaviours? There are many barriers that may prevent knowledge (i.e. data) from passing through that behavioural lens and that need to be addressed to maximise any market-shaping effort. As outlined in an earlier article, HCPs, like most of us, are habitual creatures. They have engrained beliefs and entrenched behaviours which drive them to apply mental shortcuts (cognitive biases) to efficiently operate on a daily basis. Cognitive biases can diminish the impact of new data and limit a provider’s ability to interpret and act on relevant information. This can ultimately lead to continued habitual prescribing and inertia, resulting in poor adoption of new therapies. Other behavioural factors, like self-efficacy and perceived control, may also impact whether or not an HCP will consider new data or adopt a new product, and thus need to be a key focus of a market-shaping campaign. For example, a lack of self-efficacy may account for a provider being hesitant to prescribe a new, innovative therapy because it requires that they learn how to perform a new skill or procedure that may make them apprehensive or uncomfortable. Perceived control is a provider’s beliefs about how his/her decisions and actions influence patient outcomes. In many chronic diseases, the burden of management largely falls on the shoulders of the patient. The choices patients make every day, such as what to eat, whether to exercise, and how to manage symptoms, are in their hands. Additionally, patients may feel there are barriers that are preventing them from taking their medication as prescribed. All of these factors may make providers assume that they have limited ability to influence patient outcomes, which may decrease their motivation to act. How can pharma redefine market shaping? Optimal market-shaping efforts do more to actively prepare the market to adopt new products by addressing both the clinical and behavioural lenses which ultimately drive HCP prescribing behaviour. These efforts go beyond simply providing HCPs with knowledge of an unmet need and how a product will meet that need. They address HCPs’ motivation and skills. Knowledge is already the focus of most market-shaping campaigns. The need to educate HCPs on current therapeutic options, treatment guidelines, expected outcomes, and relevant data will always be a key component of any market-shaping effort. Knowledge is important, but knowledge alone is often not enough. Motivation is a key driver of behaviour change. Sometimes knowledge of unmet needs and burdens can help provide motivation to adopt a new therapy that addresses these, but motivation alone is also not enough to change behaviour. To break through habitual prescribing and inertia, we need to address behavioural factors like perceived control and cognitive biases. We need to help providers become self-aware in how they practice and how they perceive their patients. By doing this, we can drive increased perceived value in a new therapy and motivation to prescribe. Using behavioural science to drive motivation Cognitive debiasing techniques such as bias inoculation and cognitive forcing can be applied in practical ways or in practical learning situations (e.g. conferences, symposia) and in a variety of contexts (e.g. through case studies). These experiences guide providers through scenarios where they can analyse their decision-making and work through a deliberate thought process and consideration of alternatives. These techniques help providers stop and think and can open the door to new ways of thinking. Skills can often refer to the need to learn how to perform a new procedure or use a new device. But we need to go beyond the procedural and think about that behavioural lens. We may need to help HCPs with other skills that will ultimately impact the success of a product launch. These may include ensuring providers:

• Can identify patients that are not optimised on treatment or are struggling with other unmet needs
• Are asking about and identifying individual patient preferences
• Have optimal communication skills to identify patients who are ready to start a new treatment from a psychosocial perspective
• Have the tools they need to encourage patients to track symptoms

Using behavioural science to build skills Implementing active learning into promotional activities or training can be one way to help build procedural skills. But we need to do more to help equip providers to look outside the box and break through their biases. For example, helping providers build communication skills by showing them how to use techniques like motivational interviewing or to apply shared decision-making in its true form can help them identify patients who may not be optimised on treatment and/or appreciate individual patient preferences (e.g. for a particular mode of administration). Behavioural science provides a roadmap to understanding how HCPs make decisions and what drives prescribing behaviour, but also, more importantly, it gives us strategies that we can apply to disrupt the status quo. By addressing knowledge, motivation, and skills, market-shaping campaigns can work harder and smarter to begin to shift provider behaviour before a product even becomes available and allow for accelerated uptake at launch. About the author Patty Zipfel, VP of scientific strategy, MicroMass Communications Patty blends her expertise in scientific strategy and practical knowledge of healthcare provider behaviour to make impactful contributions at every level of MicroMass’s communications offerings. These include solutions ranging from traditional medical communications to behavioural interventions that help bridge the dialogue between healthcare providers and patients. Patty has broad therapeutic expertise including experience in cardiovascular, respiratory, gastroenterology, neurology, and oncology. She also has deep experience collaborating with expert healthcare professionals to understand and address beliefs and behaviours related to prescribing and the therapeutic experience.