Table 3

Value elements relating to the process of care

Value elementRationaleImplicationsIssues
Invasiveness of care processesThere are established preferences for less invasive treatments, such as oral rather than parenteral administration65 and minimally invasive rather than open surgical procedures.43 QALY benefits may be foregone in favour of preferred, less invasive, treatments.Requires a method for quantifying the process utility and incorporating this in decision making.
Convenience (eg, choice of location and timing)Evidence that people prefer, and are willing to pay for these aspects of healthcare provision.66 QALY benefits may be foregone in favour of service aspects such as location and timing, which may require additional capacity and flexibility.Patient choice has been seen as a political priority,67 but may tend to increase health inequalities.68 69
Autonomy, self-determination and participationEvidence that patients value participation in shared decision making and that this may also result in improved clinical outcomes in some cases.70 Choice and autonomy may also have intrinsic value.71 Patients may have personal preferences for treatment options that appear less cost-effective, based on a societal perspective.There are several overlapping issues; autonomy may be associated with improved outcomes, individual patient preferences may differ from societal preferences, and societal preferences may value the availability of choice as a separate ‘good’.
Dignity, respect and compassionAspects of care such as privacy and being treated with dignity, respect and compassion are highly valued by patients.26 31 Dignified and compassionate care may require resources for suitable facilities, staffing training and supervision, which need to be traded off against resources devoted to health benefitsThese are complex concepts which may be difficult to define and measure.
  • QALY, quality-adjusted life-year.