Determining what matters most to patients: qualitative interview techniques and methodological considerations for concept saliency analysis and reporting

This commentary considers how qualitative interview techniques can be used to determine the relative importance or saliency of concepts reported by patients in clinical outcome assessment (COA) development. The objective of this commentary is to explore how researchers can identify which symptoms and impacts are most important to patients using qualitative methods. The paper aims to promote alignment on best practices and terminology. This commentary discusses the implementation of structured qualitative interview tasks that are commonly used to assess concept saliency, including the definition and application of thresholds. These methods are discussed in the context of concept elicitation interviews, with considerations for their design, implementation, and analysis. Ranking and rating tasks offer structured approaches to eliciting concept importance, each with distinct advantages and limitations. Ranking tasks are efficient and engaging but may oversimplify concept prioritization. Rating tasks provide nuanced data but can be time-consuming and burdensome. The authors consider current use of saliency thresholds to be inconsistent, with research generally lacking predefined criteria. A mixed methods analysis approach, combining qualitative insights with descriptive statistics, is recommended by the authors to ensure comprehensive understanding of patient experience. Structured interview tasks enhance the rigor and relevance of qualitative research in COA development. By standardizing terminology and analysis approaches, researchers can more accurately identify and prioritize concepts that matter most to patients. This ensures that measurement strategies in clinical trials and real-world studies are truly patient-centered.