Eliciting societal views on the value of life-extending treatments using Q methodology

Publicly funded healthcare systems operating with fixed budgets must incorporate rationing mechanisms of some sort in order to set priorities. Efficiency, which might be defined broadly in health terms as maximising health benefits with respect to cost, is a key consideration in setting priorities. However, efficiency is not the only consideration, and members of society may value other issues in relation to the distribution of resources to different groups of beneficiaries. Life-extending treatments for people with terminal illnesses, which are non-curative by definition and often produce relatively small health gains in relation to their costs, are a prime example of technologies that might not satisfy usual cost-effectiveness thresholds. It is generally accepted that the views and values of members of the public, as taxpayers and potential patients, are relevant in determining priorities in the provision of publicly funded healthcare. This chapter introduces Q methodology as a structured approach to eliciting and describing societal values, combining qualitative and quantitative techniques to study subjectivity, with reference to research carried out relating to people at the end of their lives.