OBJECTIVES: FDA guidance for PROs has led to an increased reliance on qualitative methodologies to identify relevant domains for instrument development. Concept elicitation (CE), which underpins the development of PRO instruments, often relies on exploring patient experience through the lens of the patient as it relates to disease burden and the impact on activities of daily living.  Yet the deeper emotional experience of patients is missed.  We address this gap in methodology by reviewing how the use of a structured model for emotions can improve PRO instrument development by strengthening the role of emotions during CE. METHODS: A literature review of CE with emotional motivations was undertaken to identify the most salient aspects for PRO instrument development.  RESULTS: The method for eliciting emotional motivations is based on motivation research and extraction techniques (see Forbes, 2010) containing, nine distinct categories of emotional motivation.  The CE protocol relies upon neuroscience research (see Damasio 2010) which points to the power of a sub-800 millisecond response frame for eliciting purely emotional reactions to stimuli. Images validated in large sample research as uniquely evoking one of the nine motivational emotions are the stimuli for this emotional evocation procedure. This augmentation to typical CE has been used repeatedly to identify needs for emotional health among sufferers of diabetes, arthritis, and heart disease – in each case linking evocations to absence of needed emotional energies that could promote self-care and disease recovery. CONCLUSIONS: CE techniques for most PRO development do not allow investigators to sufficiently understand the patient experiences of physical symptoms, effect of ADLs, and the emotional consequences of a disease or condition of interest. Adding emotional motivation techniques to CEs will broaden our ability to capture the emotional experiences of patients so that related PRO instrument items may better represent the experiences of patients' suffering from various medical conditions.