Discussion: Attending to Values and Quality of Patient Involvement in HTA
This chapter discusses Part I of this book, which has provided an introduction to the history and development of HTA and to the various rationales for, and forms of, patient involvement within it. One of the points that recurred in the introductory chapters was the sense that patient involvement in HTA is 'still contentious' to some people (Sect. 5.4), and in part because of concerns such as 'scientific debate gets softened by inclusion of patients' perspectives' (Table 5.1), and patient involvement is 'a potential hazard in achieving independent evidence-based decisions' (Sect. 3.1). To address these concerns effectively, we suggest it will be important both (1) to identify, challenge and avoid perpetuating any unfounded assumptions or faulty reasoning that might lie behind them and (2) to ensure that advocates of patient involvement in HTA avoid overstating its merits, acknowledge variability in its quality and promote the most robust and defensible approaches. In what follows, we offer a few suggestions to support both kinds of endeavour. We do this in the interests of ensuring that, moving forward, patient involvement is discussed and developed in ways that not only fulfil its advocates' aspirations that it will improve HTA but that can also convince those who are currently sceptical about its value. Our comments apply primarily to patient involvement in assessments of particular health technologies rather than in HTA policy or the development of HTA processes more generally.