Causality, Complexity and Evidence in Health Sciences

By Keith Meadows and Matt Reaney

For many years psychologists and other social scientists have been pushing for the individual patient’s perspective – priorities, needs, feelings and functioning – to be incorporated into drug development. This is usually achieved through the use of patient-reported outcome measures (PROMs) in clinical trials. The development and use of PROMs situates them at the vertex of two very different trends in medicine: patient-centred care and standardization. Indeed the application of PROMs – which pull in the direction of standardisation – results in a narrow conception of evidence by overriding the subjectivity of individual experiences, beliefs and judgments. Without additional context, PROM data cannot easily support individual patient-level care. When collected systematically and with an interpretive phenomenological approach, narrative data can contain valuable information about the patient experience that numerical ratings from PRO measures do not capture.