Mobilizing for Patient Adherence to Cancer Therapies (mPACT)
The Problem
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Oral anticancer medications (OAMs) place greater responsibility on the patient and/or caregiver
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Medication adherence rates could be as low as 16%. The positive therapeutic outcome is in direct correlation to adherence to OAMs
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Time constraints during in-clinic visits also present a problem for clinicians to effectively deliver information
There's a need for finding engaging ways to encourage and empower patients to take more control over the situation even when taking cancer drugs with strong adverse effects.
During the initial consultation with an oncologist, patients are provided with a large amount of information on the disease, treatments, options, and side effects - receiving information overload when the only word they might hear and focus on right after receiving the “bad news” is “Cancer.”
The Solution
An interdisciplinary team at the University of Illinois at Chicago (UIC) has developed a personalized mobile application (app) to address some of the factors contributing to non-adherence to OAMs.
The goal of this research is to design a customized mobile application that can empower low health literacy patients taking OAMs and serve as visual aids in facilitating communication between patients and their health care team. A User-Centered Design approach was implemented by consulting with clinicians and patients at an early stage of development. Animations were incorporated to distill complex medical concepts and information. An iterative design process ensures that the tool is customized for patient engagement and would be a tool that oncologists and pharmacists would want to use during their consults.
Why a mobile app?
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Mobile devices such as tablets and smartphones are becoming universal and often more widely utilized than desktop or laptop computers
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Many clinicians already use a mobile devices in their clinics
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Tailoring content to make eHealth interventions more personally relevant promotes patient engagement and post-intervention behavioral changes among patients
Why Animations?
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There are many solutions proposed or implemented to help patients retain complex medical instructions
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Studies have shown that pictures help patients recall information given to them at the clinic.
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Spoken medical instructions averaged 14% recall rates, but when pictographs accompanied the spoken instructions were presented, 85% of medical instructions were remembered correctly
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Animation has been found to be more effective than live-action video for conveying symbolic concepts
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The use of a mobile device in conjunction with animation could significantly improve patient understanding and clinician-patient communication. This was demonstrated to be especially effective in use with low health literacy populations since animations can overcome issues of literacy and are perceived as non-threatening when used to deliver medical information
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mPACT is designed to be completed within 20 minutes so that the patients can go through it in the clinic or oncology pharmacy waiting room or during counseling with clinicians. It will educate patients on a specific oral chemotherapy drug(s) that they are taking, follow-up appointments, and prescription refills. Text messages will be sent at regular intervals to intervention subjects. Personalized data are taken from specific patients' EHR to ensure that the information is customized.
Pre-Production Scope Assessment
Pre-production scope assessments were conducted with clinicians (i.e., oncologists with board certification in internal medicine and hematology and two board-certified oncology pharmacists) to gain an understanding of the most important information they want their patients to remember. Based on these clinician interviews, we prepared a sitemap that indicated the education modules to include in the application.
The functionalities of the mobile application include:
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Patient-centered educational tutorials on the specific OAM they are prescribed, including pictures of the OAM that the patient is prescribed and his or her specific dose and schedule
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Patient scenario modules based on clinician-identified, common adherence barriers for patients
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Customized medication calendar
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Sending tailored text messages via cell phone for reinforcement of take-home messages and follow-up appointments.
The four barriers addressed in the patient scenario modules are:
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The on-off schedule for some OAMs
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Confusion regarding changes in dosing
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Side effects have been known to cause patients to stop taking their OAM because they could not tolerate them
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Forgetting to pick up refills in a timely manner.
Wireframes
The wireframes were prepared in Adobe InDesign. Wireframes were produced based on the site map. These are black and white pages without any graphic design elements. They provide the functionality information on each page. They show what interactivity, navigation buttons, images or videos, and text boxes would be included in the modules.
UI Designs
Three different user interfaces (UI) were designed with the final selection of soft, desaturated hues with graphic elements that have contrast in saturation or hue to organize information hierarchy. The first design was minimalist with the use of white as a background and blue-green hues for graphic elements. The second concept was inspired by the yellow daffodil symbols for cancer charities. The overall design followed a traditional linear book layout, using the guidelines by the US Department of Health and Human Services website development. The third concept was more dynamic in appearance, with icons that resemble mobile app icons, and with more graphic elements compare to the first two designs. We avoided sharp edges in all three concepts, with circles; curves, and rounded corners being used as design elements since it was not desirable to have harshness associated with this application. Sans serif fonts were chosen because they are crisp and easier to read on screen than serif fonts and have been shown to be more readable among elderly populations.
Patient Interviews
Informal, semi-structured interviews were set up, where patients evaluated the prototype of the three different UI as well as the animations. They evaluated 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.
The patients perceived the four patient scenarios modules as being very helpful. This represented a form of “role modeling” as the basis for introducing the story to promote patient identification between the actual patient and the fictional patients in the scenarios. This type of representation has shown to be very effective in modifying behaviors. The participants related to the patient scenarios very well and felt that they would be helpful in preparing the patients taking OAMs for some of the potential obstacles.
The UI design concept 2 was preferred by most with its warm hue and more straightforward linear navigation. Simple, easy-to-understand visuals that focus on what they need to know and what buttons to push to navigate were perceived as more welcoming. The design of the UI in concept 1 with its mostly white background and blue graphic elements was seen as “cold and clinical” by the patients. The finalized UI incorporates all the elements preferred by the patients we interviewed.
Reflection
Consulting the target audience in early development can help us determine preferences and identify any need for new system features and design requirements that we did not implement. One of the patients would like us to host an online community for them. At the time of user testing I only interviewed two patients, it would be interesting to hear from more people regarding the UI design and the functionality of the app. One of the feedbacks from the patients was that there is too much text in the patient scenario module; perhaps I could have designed an infographic with minimal text to summarize the same information.
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