User-Centered Design Utilized to Develop App for Oncology Patients
Written on December 8, 2016 by Grace I-Hsuan Hsu
Ensuring patients take their medications as prescribed by their doctors is an ongoing issue across the world. That’s even the case for patients with life-threatening diseases like cancer. Patients cite a number of reasons for failing to take oral anticancer medications (OAM), including confusion around when and how to take their pills. This is something I’ve witnessed firsthand.
As part of a master’s research project at the University of Illinois at Chicago, I shadowed an oncology pharmacist and pharmacy student as they gave medication instructions to a patient who was diagnosed with cancer for the second time.
The patient had experience taking OAMs before, but that didn’t make it any easier for him to retain all the directions that come with these types of medications. For example, the chemotherapy drug prescribed to this particular patient comes in 150 mg and 500 mg pills. To get the correct dosage, he had to do some math to get the 1800 milligrams he needs per day. The meds must also be taken for two full weeks every 21 days. Discussion about side effects is also part of the consultation.
Even with a background in pharmaceutical sciences, I would not have remembered the verbal instructions had I not written and doodled them down in my sketchbook. For OAMs there is a greater responsibility for the patients to make sure that they follow their prescriptions precisely (in contrast to IV chemotherapy). For effective self-care, patients need to be engaged and well informed.
Developing a Solution to OAM Non-Adherence Using User-Centered Design
An interdisciplinary team at the University of Illinois at Chicago (UIC) has developed a personalized mobile app to address some of the reasons cancer patients fail to take their medications correctly. The goal of this project was to design a customized mobile app to empower patients taking OAMs and serve as a visual aid in facilitating communication between patients and their health care team.
My role was to incorporate user-centered design to create the user interface (UI) of the app, distill medical instructions in a visual way to engage the patients, and interview clinicians to determine what problems or challenges they are having and how we can overcome those challenges and deliver an effective educational tool.
My research found that cancer patients have a difficult time processing all of the information communicated to them by physicians because there’s so much to retain and they are already in a vulnerable, emotional state. Time constraints during in-clinic visits also present problems for clinicians to effectively deliver intervention details to patients.
My team decided to incorporate pictures and animation into the mobile app to help patients more easily understand the complex medical instructions they must follow. Studies have shown that pictures help patients form a mental model of a situation and enhance comprehension of text. It’s also been determined that use of a mobile device, in conjunction with animation has been shown to significantly improve patient understanding and clinician-patient communication, especially in low health literacy populations.
The app my team created is designed so patients can utilize it in the oncology pharmacy waiting room or during counseling with clinicians. The functionalities of the mobile app include:
- Patient-centered educational tutorials that include pictures of the specific OAMs prescribed along with information on the specific dosage and schedule.
- Patient scenario modules that allow patients to role play what they are supposed to do in certain medical situations.
- Customized medication calendar.
- Tailored text messages for reinforcement of take-home instructions and follow-up appointments.
- Personalized data are taken from specific patient’s electronic health record to ensure the information is customized.
How Did Patients Respond?
We gave patients the opportunity to evaluate prototypes of the different user interfaces UI) as well as the animations. They gave us their opinions on the icons used, the colors, font type, font size, and the layout and graphic elements in each design as well as the style of the animations.
We found that the patient scenario modules allowed patients to identify with the fictional patients in the scenarios, and were effective in modifying behaviors. By involving patients early in the design and development process, we invited them to be an integral part of their own cancer treatment team.
Current State of the Project
The application is now coded and hosted on Health Insurance Portability and Accountability (HIPAA)-compliant servers allowing tablets to access patient electronic health records. The research team is conducting a feasibility study at the UIC Cancer Center to evaluate this mobile education tool and how it will contribute to patients’ adherence to their OAMs and our understanding of the function served by visual aids in facilitating communication between patients and their health care team. Jump Simulation could help test the application in a Phase II study, pending grant funding.
Grace I-Hsuan Hsu, a creator of miniature critters and tea sets, is an Experiential Instructional Designer-Developer at Jump Simulation. She has a background in biochemistry (University of Waterloo) and biotechnology (Harvard University), in addition to over 9 years of basic and pharmaceutical research. She earned her MS in Biomedical Visualization from the University of Illinois at Chicago in 2015. Her research interests lie primarily in medical/patient education, from designing effective and engaging user experience to communicating cutting edge medical/scientific discovery. She enjoys translating complex information into something relatable for the target audience.