Value elements relating to the process of care
| Value element | Rationale | Implications | Issues |
| Invasiveness of care processes | There 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 participation | Evidence 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 compassion | Aspects 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 benefits | These are complex concepts which may be difficult to define and measure. |
QALY, quality-adjusted life-year.