Qualitative approaches to understanding patient preferences.

Achieving patient-centered care depends on a thorough understanding of patient preferences at all stages of their journeys through healthcare. Qualitative research methods provide the means to systematically collect and analyze these preferences. Qualitative approaches to research are diverse in character, but many such approaches have a long history and strong disciplinary roots. Despite variation, most qualitative approaches work inductively from the 'ground up', and seek to build knowledge and understanding rather than test hypotheses. Their use to explore patient pathways through care has offered insight into reasons why people become patients in the first instance, their preferences for treatment options and degree of involvement in decisions, and their preferences for healthcare delivery. Qualitative approaches are sometimes used alongside 'quantitative' in mixed methods designs, requiring solid expertise and resourcing. Expertise is also crucial in the assessment of quality in qualitative research, and efforts to develop checklists to assess quality are challenged by evidence about the importance of expertise-based judgments. Recent developments in health research include an upsurge in patient involvement activities in design of research and healthcare services; these may seem similar to qualitative research, but are in fact very different. While an important part of the research landscape, patient involvement activities are not intended to provide robust research-based evidence about patients' preferences or experiences. There is pressing need to bridge the gap between qualitative research evidence and patient involvement in the design of research and services. Participatory research methods that harness qualitative approaches may be a way to achieve this.