Improving The Patient Experience With Design

Improving The Patient Experience With Design

Process Book

December 2020

By: Kate Fox

Thank You

Michelle Carpenter Travis Vermilye Brian Deleive Dr. Christian Josh Blair Katey Marquette Joey Gasiorek

Table of Contents

6. Problem 7. Solution 8. Design Question 9. Mission Statement 10. SME/DME Mentors 14. Interviews 18. Research 19. Findings 30. Personas 32. Deliveries 33. Creative Brief 34. Script 35. Storyboard 36. Moodboard 37. Style frames 38. Final Video 39. Next Steps 40. Bibiography

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Learning about Breast Cancer can be overwhelming and challenging to retain due to it being a traumatic event in someone’s life. Design can help enhance information and create a visual connection that people can refer to later when learning information. Along with design, analogies and metaphors have shown a positive impact in communicating medical information to patients. These two aspects combined can help Breast Cancer patients comprehend more information given to them and refer back to when explaining what they learned or know to a family member or friend.

THE PROBLEM

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Patient Experience

Solution

Incorporating design and analogies through a series of motion pieces can help improve the educational experience for breast cancer patients.

Changing the way information is presented within the medical field will expand how patients understand and comprehend their information.

Breast Cancer Education

THE SOLUTION 7

How can visual analogies improve the learning experience for Breast Cancer patients?

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THESIS QUESTION

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Improving The Patient Experience With Design.

MISSION STATEMENT 9

NICOLE CHRISTIAN, MD ASSISTANT PROFESSOR, SURGERY-SURGICAL ONCOLOGY Dr. Christian is a Surgical Oncologist. She has practiced at CU Specialty Care at Highlands Ranch Breast Care, University of Colorado Hospital (UCH), CU Breast Surgery - Cherry Creek Medical Center, and UCHealth Ambulatory Surgery Center - Cherry Creek Medical Center.

Her clinical interest for patients is dedicated to multi-disciplinary care of breast disease. She specializes in the surgical care of benign, high risk, and malignant breast conditions. These include lumpectomy, mastectomy, nipple-sparing mastectomy, and axillary staging. Her conditions and treatments revolve around Cancers and surgeries— specifically, breast cancer, cancer surgery, and breast surgery.

SME

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TRAVIS VERMILYE ASSOCIATE PROFESSOR, DIGITAL MEDIA ARTIST Travis Vermilye is a digital media artist. He got his MFA in Medical & Biological Illustration from the University of Michigan and his BS in Biological Illustration from the Southwest Missouri State University. He is known for creating work influenced by nature and science. He is a Professional Member of the Guild of Natural Science Illustrators and a member of The Design To Improve Life Education Academy. He is a professor for the Digital Design and Illustration department of Visual Arts, College of Arts & Media, at the University of Colorado Denver. He teaches courses in 3D Motion Design, Anatomy for the Artist, Biomedical 3D Animation, Design Studio 1, Drawing 1, Intermedia Foundations, Introduction to Digital Design, Motion Design, etc.

DME

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KATEY MARQUETTE FREELANCE ARTISTS, DIGITAL MEDIA ARTISTS Katey Marquette is a Freelancing graphic designer. She graduated from the University of Colorado Denver with a graphic Design degree in 2017. She started her own company, Caliper Productions, to connect with clients to create animations, illustrations, and brand developments.

It has grown to make short films with her partner, Joey Gasiorek. Her knowledge and skills in digital design allow her and her partner to create excellent work for their clients.

DME

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JOEY GASIOREK FREELANCE ARTISTS, DIGITAL MEDIA ARTISTS Joey Gasiorek is a Freelancing graphic designer. He graduated from the University of Colorado Denver with a degree in visual effects and motion graphics in 2013. At the beginning of his career, he worked for a news company to create their visuals and animations. He started his own company, Caliper Productions, to connect with clients to create animations, illustrations, and brand developments. It has grown to make short films with her partner, Katey Marquette. His digital design and animation knowledge and animation skills allow him and his partner to create great design and motion pieces for their clients.

DME

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INTERVIEWS

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INTERVIEWS

DME TRAVIS VERMILYE Travis Vermilye and I discussed how to address the problem I am interested in creating a solution. Travis mentions how IDEO tackles a question by thinking about it as a “how might we…” question. I made it clear to Travis that I wanted to focus on breast cancer to understand myself as a woman better, and I know it is like losing someone from it. For my initial thesis idea, I was thinking of creating a piece shown by a surgeon or oncologist specializing in breast cancer. However, he brought up an alternative approach. He presented the idea of creating a patient education piece. He made it clear that I need to focus on thinking about what the patient cares about. Travis mentions how patients are more concerned about how this is going to affect their life. At this point, I realized that I wanted to create an educational piece rather than focus on a procedure.

On top of understanding how to address my question, I also wanted to focus on how and why visuals affect how people intake information. He suggested looking into AMI.org, Journal of BioCommunications, and the Journal of visual health communication in medicine for detailed information on the topic. He mentioned working with a medical campus group studying patient decision aids such as paper, website, or videos. The results showed that video delivery was best. Lastly, I wanted to get his perspective on a color pallet to consider. He recommended using soft and subdued colors. He clarified to use white, not to represent muscle as a bright red but rather a light subdued pink, and that arteries are a fleshy toned color, so avoid representing them as bright red and blue.

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INTERVIEWS

SME NICOLE CHRISTIAN, MD Dr. Christian’s knowledge and experience as a licensed surgical oncologist allowed her to clarify or correct the information I had gathered. With her being a part of the faculty at Anschutz medical campus, I wondered if they used visuals for their patients to explaining a procedure.

She reassured me that they do. She demonstrated this by creating a drawing. She uses sketches to point out the location of the tumor to her patients. Additionally, I asked if she could explain the function of an I-125 seed. She clarified that surgeons use radioactive seeds to help them find the tumor within the breast. There are magnetic seeds, radar frequency seeds, and wire localization alternatives. At the University, they use a SAVI SCOUT, which is a radio frequency seed. I learned that a Ductal Carcinoma in Situ (DCIS) is considered a philosophical controversy. In her words, A DCIS is

“preinvasive cancer. The definition of “in Situ” is the ability to invade. DCIS is a local process in the breast that we believe, if left alone, will eventually develop the knowledge to invade. The difference (between a regular cell and a DCIS cell) is that the DCIS cells have not broken out of the duct yet”. Also, she clarified that there are 10-30 lymph nodes found under the armpit and the sentinel lymph nodes are what the breast drains into. Lastly, Dr. Christian brings up an analogy she uses for her patient’s explaining taking out sentinel lymph nodes. She describes this to her patients as an apple tree with worms in the apples. The apples found closest and lowest to the trunk of the tree are the sentinel lymph nodes. Those are more likely to have worms found in them. She provided a few other analogies, and this sparked my curiosity. I realized that to improve patients’ educational experience, incorporating visual analogies to represent facts can help.

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INTERVIEWS

DME KATEY MARQUETTE & JOEY GASIOREK Katey Marquette and Joey Gasiorek are highly skilled in using software such as After Effects, Illustrator, and Cinema 4D. With their experience in creating their own company, Caliper Productions, to create animation, illustration, and brand development, they understand how to create content for clients, which dramatically responds to their viewers. They know how to make short films that are impactful and display a clear message to their audience. They both recommend using cinema 4D for the field that I want to get into due to its ability to create detailed structures and textures for anatomy.

Having “more tools in your toolbelt,” as Marquette describes, is essential to promptly complete any project.

I wanted to get their perspective on using analogies

versus detailed representations with understanding their point of view of working with different software and clients. Katey stated that she typically averts her eyes and zones out when something graphic is presented to her. However, she comments that if the information is too flowery and abstract, it is no longer adequately explained. With her reasoning, I realized that the best approach to meet this perspective in the middle is to incorporate simplistic, abstract, and detailed imagery to present the information correctly and educationally.

Additionally, I asked about their understanding of the effects of using visuals, and their response was clear.

Their experience is that people become confused without visuals and do not understand the information.

Katey states, “when you a have visual, it transcends language.” Even when large words are used, imagery helps clarify the information.

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RESEARCH

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RESEARCH

FINDINGS

TUMOR SIZE THROUGHOUT BREAST CANCER STAGES +5cm (including the chest walls) +5cm +2cm -2cm

Tumor not detectable.

Know as precancer or DCIS.

Stage 0 Breast Cancer:

Stage 1 Breast Cancer:

Stage 2 Breast Cancer:

Stage 3 Breast Cancer:

Stage 4 Breast Cancer:

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RESEARCH

FINDINGS BREAST CANCER TERMS

When learning about Breast Cancer, vocabulary is essential.

The ten terms to expect to hear during a physician’s diagnosis are lymph, lymph nodes, sentinel nodes, early-stage breast cancer, late-stage breast cancer, invasive, metastasis, axillary dissection, lymphedema, and DCIS.

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Lymph: The fluid that fights infection and eliminates waste found in the breast and the body’s lymph vessels and lymph nodes.

Lymph node: Consists of filters found explicitly under the arm and are connected to lymph vessels.

Sentinel nodes: The first three lymph nodes under the arm that are closest to the breast that possesses the tumor.

Early-stage breast cancer: Involves stage 0, stage 1, and stage 2, which typically revolve around surgery rather than chemotherapy because the tumor can be easily removed.

Late-stage Breast Cancer: Involves stage 3 and stage 4. These are more severe and revolve around getting Cat-scans, Bone scans, PET scans, chemotherapy, and surgery.

Invasive: Cancer cells from inside milk ducts or lobules break out into nearby breast tissue.

Metastasis: Cancer has spread to a different part of the body.

Axillary Dissection: The removal of sentinel nodes.

Lymphedema: Lymphedema is the swelling under the arm after an axillary dissection or the removal of the sentinel nodes.

DCIS: A precancerous condition where cells evolve and might evolve into invasive cancer that can invade other parts of the body.

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RESEARCH

FINDINGS

WHAT TO EXPECT DURING STAGE OF BREAST CANCER Each woman’s breast cancer is different

Chemotherapy

Systemic Therapy

PET/CT/Bone Scan

Surgery

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When a patient gets a mastectomy with stage 0 Breast Cancer, they will also receive a sentinel node biopsy.

Stage 0 Breast Cancer: Lumpectomy or Mastectomy

Stage 1 Breast Cancer: Lumpectomy or Mastectomy

Sentinel Node Biopsy

Lumpectomy or Mastectomy

Sentinel Node or Axillary Lymph Biopsy Node Dissection

Lumpectomy or Mastectomy

Sentinel Node or Axillary Lymph Biopsy Node Dissection

Stage 2 Breast Cancer:

Stage 3 Breast Cancer:

PET/CT/Bone Scan

Stage 4 Breast Cancer: Chemotherapy or Systemic Therapy

PET/CT/Bone Scan

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RESEARCH

FINDINGS Z11 TRIAL

The Z11 trial was revolutionary for breast cancer patients. Evaluating a patient is referred to as the patient’s clinical stage.

The physician evaluates the tumor size, the lymph node status, and whether the patient has the metastatic disease (TNM). When the physician examines the patient by looking at their imaging and a pathologist looks at the tissue under a microscope during surgery, about 15-20% of the time, they will find evidence of cancer within the tissue. This is called a patient’s true pathological stage.

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RESEARCH

BEFORE Sentinel Node Biopsy

Axillary Lymph Node Dissection

Axillary Lymph Node Dissection

During surgery, a patient’s sentinel lymph nodes would be taken out to examine evidence of cancer within them. If there was evidence of cancer in only one or two of the lymph nodes, the surgeon was permitted to proceed with an axillary dissection. An axillary dissection causes the adverse side effects of lymphedema.

AFTER If not all sentinel lymph nodes show cancer in them, it is not necessary to proceed with an axillary dissection. This avoids the side effects of lymphedema for the patient.

However, if three or more are positive for cancer, an axillary dissection is necessary.

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RESEARCH

FINDINGS BENEFITS OF VISUALS

Visuals have proven to help the learning process for someone to comprehend tasks and gain learning skills. Children with Autistic spectrum disorder (ASD) and Attention Deficit Disorder (ADD) significantly benefit from this kind of learning. Visuals have helped children with literacy skills, condition attention difficulty, help hyperactivity, and improved school learning. Visuals help create structure, positive behaviors, and notify changes in activities. Lastly, visuals increase those with ADD to focus on the message and help reduce anxiety making abstract concepts more concrete for the individual and helping them express their thoughts.

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RESEARCH

FINDINGS BENEFITS OF VISUALS

In a study conducted by Laura S. Lorenz and two co-facilitators, brain injury survivors were asked to do a photovoice. This task entailed the brain-injured survivors to use a camera to take photos that help reflect how they felt in their daily lives after their injuries. Photovoice illuminates the human experience of health and illness. It allowed participants to share their experiences and provide data to help researchers understand how their visuals allowed them to express their thoughts and difficulties.

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RESEARCH

FINDINGS ANALOGIES IN THE MEDICAL FIELD

Analogies have had an immense role in the medical field. By comparing cancer to battle scenarios, analogies have helped people understand the information and motivate them to stay strong in the fight. Analogies of reallife experiences generate a personal understanding and communicates that understanding to others. Analogies are positively impactful in life-altering situations as it provides motivation and purpose for an individual. Battle analogies give some cancer patients a fighting spirit mindset that helps them feel more in control. Being a fighter offers a person with cancer a sense of purpose, identity, and meaning.

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RESEARCH

CONCLUSION When we receive vital information, it is essential to understand and comprehend what is being given to us. However, it can be challenging to do so when the information provided to us is new and one has questions running through their mind. With research proving how impactful visuals and analogies have on people, it becomes notable that incorporating design and analogies can help others understand breast cancer information. Although some brochures and pamphlets provide vital information, it is time for an update to improve the patient experience.

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RESEARCH

PERSONA Extrovert

Bio I am a mother of two beautiful daughters. After finding out I have stage 2 breast cancer, my family and friends have been so supportive.

I struggle to understand what is expected to happen to me. I’ve talked to other breast cancer survivors about their experience, but everyone’s experience is different, even from mine. My doctor has helped guide me through what will happen, but I often do not understand the terms or have something to compare it to when explaining it to my friends and family.

Thinker Judging

Introvert Feeler Perceiving

Frustrations Mary A. Watson Age 41 Occupation Bakery manager Education BA FINE ARTS Location Bolder, CO

• Not knowing what to expect • Having bad thoughts • Feeling overwhelmed Motivations • Hearing breast cancer survivor stories • Yoga • Receiving encouragement from my family and friends

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RESEARCH

FINAL THOUGHTS After speaking with a few breast cancer survivors and family members, I have a better understanding of my targeted audience.

I learned about the questions they had during the initial process that their physician answered. Some things that were not mentioned and many people wish were answered during that time. By incorporating my findings from research and interviews, I have organized a solution that can benefit the educational experience and the patient experience for breast cancer patients.

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DELIVERIES

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DELIVERIES

CREATIVE BRIEF 33

DELIVERIES

SCRIPT I have Breast Cancer. What does this mean? What stage of breast cancer do I have, what is the next step? Will I need chemotherapy? What is going to happen to me? These questions may be going through your mind at this moment. Please allow me to break this down. First, allow me to provide a little background on what Breast Cancer is. Breast cancer occurs when DNA in a cell is altered. The altered cell begins uncontrolled cell growth in an area of the body. This aggressive cell growth can create a tumor which is known as cancer. For Breast Cancer, common locations reside in the milk ducts or lobules where milk is produced.

There are 5 stages of breast cancer starting from stage 0 breast cancer to stage 4 breast cancer. Let us dig deeper into what the differences are from a battlefield perspective. You are a soldier fighting for your body that is being invaded by an enemy. The

enemy is cancer cells. During the first three stages of invasive breast cancer, the enemy has taken over parts of your body. Thankfully, chemotherapy should be able to stop the attack. Your team of doctors will research where the enemy is hiding. With the use of a radioactive tracker and blue dye, your team of doctors finds the enemies location and starts a plan for attack with radiation and or chemotherapy.

Now let us say you are experiencing stage 3 or 4 breast cancer. The enemy has figured out how to branch out to different parts of your body.

Fortunately, you and your team of doctors has already figured out where the enemy is hiding and they have a plan of attack. Your skilled team will remove the cancer and destroy the enemy allowing you to reclaim your territory. In the end, this was a hard battle, and your life will slowly get back to the way it was. To learn more, visit my Youtube channel.

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DELIVERIES

STORY BOARD Shot: Medium Content: 1-8 women are likely to have breast cancer. One image is highlighted Movment: Still

Shot: Extreme close up and medium Content: Talking about how cancer grows starting from the DNA strand Movment: Slow motion

Shot: Extreme close up Content: Cancer cells growing Movment: Shaky cells growing

Shot: Wide view Content: Image of contry representing the body/breast Movment: Slow pan out

Shot: Medium Content: Image of a nurse or medic representing chemotherapy Movment: Slow pan out

Shot: Medium Content: Bomb representing chemotherapy Movment: Still

Content: Speachbubbles that will pop up with additional information such as term definitions or breast cancer survivor comments.

Movment: N/A

Shot: Medium Content: Cell (enemy) hiding behind a wall Movment: Slow pan in

Shot: Close up Content: Final shot of the patient making it through having breast cancer Movment: Still

Shot: Extreme close up and medium Content: Explaining the milk ducks Movment: Still

Shot: medium Content: Voice over the says “What does this mean?” which a patient would question.

Movment: Words fall down into the floor

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DELIVERIES

MOODBOARD

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DELIVERIES

STYLE FRAMES Simplistic Form: Diverse range of women potential of having breast cancer. Using simpler forms for my characters throughout the piece helps differentiate and creates less distraction to the view as they take in the information being provided to them.

3D Modeled Cell Forms: Using 3D models allows the viewer to comprehend the facts being explained to them without being overwhelming realistic to avoid them from diverting their eyes from the video.

Increases the impact of the information using comprehensible visuals.

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DELIVERIES

FINAL VIDEO https://youtu.be/AehSr6X9HzU

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DELIVERIES

NEXT STEPS Based on my research, it was clear that every breast cancer patient interoperates information differently. There are hundreds of analogies used within the medical field to help patients understand information and processes. I am going to continue to create a series of videos using different analogies. This way, a patient can learn from a battlefield survivors’ perspective or an apple tree perspective.

(CREATIVE BRIEF PREVIEW FOR SECOND VIDEO)

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“Attention-Deficit/Hyperactivity Disorder (ADHD) in Children - Symptoms and Causes.” n.d. Mayo Clinic. Accessed October 26, 2020. https://www.mayoclinic.org/diseasesconditions/adhd/symptoms-causes/syc-20350889.

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Breast Cancer Type and Stage: What You Need to Know. 2018. https://www.youtube.com/watch?v=ZWqfoBj2bsA. Cancer Treatment: Chemotherapy. 2012. https://www.youtube.com/watch?v=vKIRWY-LMYc. “Causes of Breast Cancer.” n.d. National Breast Cancer Foundation. Accessed October 25, 2020. https://www.nationalbreastcancer.org/causes-of-breast-cancer/.

CDC. 2020. “Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC.” Centers for Disease Control and Prevention. March 25, 2020. https://www.cdc.gov/ncbddd/ autism/facts.html.

Christian, Nicole. Interview by Kate Fox. Zoom, September 28, 2020, audio, 37:40.

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Froedtert & Medical College of Wisconsin. “Breast Cancer and Screening What You Need to Know.” Froedtert & Medical College of Wisconsin. October 25, 2020. https:// www.froedtert.com/sites/default/files/upload/docs/services/breast-cancer/mammography.pdf “High Risk Clinic | UF Health Breast Center|Overview|About Breast Cancer | UF Health, University of Florida Health.” n.d. Accessed October 25, 2020. https://ufhealth.org/ uf-health-breast-center/high-risk-clinic.

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BIBLIOGRAPHY “Invasive Breast Cancer.” n.d. Accessed October 25, 2020. http://ww5.komen.org/AboutBreastCancer/FactsandStatistics/WhatisBreastCancer/InvasiveBreastCancers.html.

Lorenz, Laura S. 2010. “Visual Metaphors of Living with Brain Injury: Exploring and Communicating Lived Experience with an Invisible Injury.” Visual Studies 25 (3): 210–23. https://doi.org/10.1080/1472586X.2010.523273.

“Mastectomy.” n.d. National Breast Cancer Foundation. Accessed October 25, 2020. https://www.nationalbreastcancer.org/mastectomy/.

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“High Risk Clinic | UF Health Breast Center|Overview|About Breast Cancer | UF Health, University of Florida Health.” n.d. Accessed October 25, 2020. https://ufhealth.org/ufhealth-breast-center/high-risk-clinic.

“Invasive Breast Cancer.” n.d. Accessed October 25, 2020. http://ww5.komen.org/AboutBreastCancer/FactsandStatistics/WhatisBreastCancer/InvasiveBreastCancers.html.

Lorenz, Laura S. 2010. “Visual Metaphors of Living with Brain Injury: Exploring and Communicating Lived Experience with an Invisible Injury.” Visual Studies 25 (3): 210–23. https://doi.org/10.1080/1472586X.2010.523273.

“Mastectomy.” n.d. National Breast Cancer Foundation. Accessed October 25, 2020. https://www.nationalbreastcancer.org/mastectomy/.

“May I Take Your Metaphor? – How We Talk about Cancer.” n.d. Cancer Research UK - Science Blog. Accessed October 5, 2020. https://scienceblog.cancerresearchuk. org/2015/09/28/may-i-take-your-metaphor-how-we-talk-about-cancer/.

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Sentinel Node Biopsy: Breast Cancer Lymph Node Surgery. 2018. https://www.youtube.com/watch?v=_02F3PnhrFc. “Words Matter: Why Cancer Isn’t a Game of Winners or Losers.” 2019. Patient Empowerment Network (blog). April 24, 2019. https://powerfulpatients.org/2019/04/24/wordsmatter-why-cancer-isnt-a-game-of-winners-or-losers/.

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