Design sprinting

Patient Persona

Accessibility needs due pain was the biggest challenge

Clinical Persona

Intertia to move to digital care amongst the traditionalist oncologist was the biggest challenge

Design Sprinting

The notes function was the most used feature and the most challenging to design with motor function limitations

For a detailed close-out report click the document on the right

CHIC_Embodie_Closeout (7).pdf

Design Sprint

First mobile app study to be published in a clinical journal NEJM

The Business Problem

Partners Healthcare has over 100K patients living with cancer, that are receiving chemotherapy. Patients on active treatment face several adverse events due to the cancer, as well as the medication, and visit the ED four to five times a year, on average. This results in over $40,000 in expenses, to manage these patients in the ED setting.

The hurdles

Our stakeholder researcher told us that patients were fairly adherent with medications, as well as everything else their oncologist asked them to do. However, the reasons for their crises were always issues other than the actual cancer. Pain and fatigue were leading causes for readmissions, but were barely being addressed when the oncologists saw these patients.

Specifically with cancer pain, there were three key barriers to addressing the issue:

Patients always tend to under-report pain. Some of them did this because they are worried that their oncologist would stop their chemotherapy, which is usually their only hope of getting better. Some also feel embarrassed to admit that they cannot handle the pain (or that the pain is getting the better of them).
Even when pain is reported, oncologists usually prescribe opioids without very specific instructions. Typically, oncologists would expect patients to take their opioids based on their pain levels. This is scary for patients who may already be worried that they will get addicted.
Addiction and tolerance are huge deterrents for patients to start taking opioids. Many patients feel nervous about starting on them and also worry that they may need to take increasing doses over time, to get the same amount of pain relief. This would leave nothing for them when they ‘needed it’.

Opportunity

Wanted a way to help them navigate their short and long-acting opioids.
The patient also said they would like to keep track of their pain.
They wanted to see patterns in their pain so they could take remedial action.
They wanted assurance that they would not get addicted to opioids if they followed automated prompts to take their medications.

Results

A randomized controlled trial was conducted at Mass General Hospital (MGH) with patients seen in their Cancer Center. Our primary outcome was to see if the use of the app changed the intensity of pain felt by patients within the last 24 hours of our assessments (at 4 weeks and 8 weeks after starting to use the app).

Accessibility

Unresolved

In the year 2013, I designed a pain management app for cancer pain for iPhone 1. Mass. General Hospital (MGH) despite being a top cancer care hospital MGH had ER readmissions in 50% of the patients. This amounted to a $10,000 loss per patient.

After 4 months of clinical and design discovery, we came up with an App for pain management. People living with cancer had excruciating pain in their joints and refused to share the severity with their oncologists as they were scared of being disqualified from the life-saving experimental chemotherapies MGH is known for. This resulted in them going to the ER as they did not understand their pain medication dosage or the pharmacology. When we created the iPhone and Android apps to test on their devices, we understood that typing, responding to long surveys, and sliding scales could be hard for the users, and we ensured the user could type with a single finger. We reduced the number of questions from 13 questions to 3. The fonts were bigger and the entire screen only had one task to do at a time. Despite us trying to accommodate all of their situational accessibility needs we could not support them well on note taking. Note taking along with the pain score every day was the most popular feature and one of the most difficult features to interact with.

This also resulted in dropping some participants during the study. This limitation was hard to overcome with the limitation of the screen size and technology in 2013.

The product then got some seed funding in 2016 and this is one of the biggest enhancements the new team will accommodate. Hopefully, text-to-type could help the users and bring us closer to supporting more users.

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