A new vision for cancer prevention

The Problem

What happens when a cancer hospital build on treating disease turns its attention to preventing it from occurring in the first place? It means re-imagining the way that people think about a hospital, and the services they expect from it. It means envisioning a bold plan for the future, but also putting those plans into motion.

Role & Team

I was responsible for leading the design, strategy, and product development of digital experiences to engage a “pre-cancer” or “high-risk” population. I lead a team of service designers, design researchers, visual designers, and developers in setting the vision and strategy for new digital services, as well as leading the testing of several prototype/mvp experiences of the services. As the lead of this “digital engagement workstream” I was responsible for working with senior members of the hospital leadership to help define and set the vision for the program, as well as managing the work of a team of 3-5 (at different points in the project,) including service designers, design researchers, a visual designer, and a developer.

Background

In 2017, MSK kicked off the Precision Interception & Prevention (PIP) Initiative, a groundbreaking research, clinical, and strategic look to rethink the way we interact with, and eventually treat cancer. The eventual goal of PIP is to create a service that is able to identify those at a high risk for cancer, build a program that monitors, engages, and supports them, and drive new research that will enable us to prevent or intercept the development of cancer before it even begins.

As MSK’s goals were initially based in research – identify new ways of detecting and intervening in the early progression of cancer – our group was brought on to understand the needs of these “high risk” populations, design and prototype digital tools and services that would meet those needs, and help the institution think through a strategic path towards implementing these solutions

User Research

When the program was initially being developed, it had a broad  set of users in mind for it, as it’s plan was to develop clinical research in several root causes of cancer. Our team ended up conducting research with several discreet populations of users over the course of the project, to understand differences as well as common needs and barriers. Those populations were:

1. Those participating in Clinical Genetics services at MSK
   • Goal: To begin to understand how MSK already engaged a non-cancer, high-risk populations around ambiguous or uncertain information.
2. Participants in an MSK surveillance program for high risk breast patients
   • Goal: To gain insight into what value those engaging in a long-term surveillance relationship are receiving from MSK.
     
3. High-Risk Tobacco Users, unaffiliated with MSK
   • Goal: To begin to understand motivations & barriers of those eligible to receive lung screenings.

Methodology

Expert Interviews: Our research included interviews with MDs, Genetic Counselors, nurses, behavioral scientists, and research and administrative staff.

Observations: Observations of Clinical Genetics counseling sessions and yearly breast screening appointments with patients.

Patient Interviews: Intercepts with patients at their yearly appointments, prompts given to understand needs at moments between yearly or bi-yearly visits.

Non-Patient/Smoker Interviews: As the program narrowed in on current and former smokers as one of it’s first use cases, we conducted interviews and early prototyping with this group, including both those who were more and less engaged with the healthcare system.

Design Principles

As we spoke with users, the following design principles developed to anchor any products and services the hospital might offer around prevention.

1. Personalize to make information feel relevant.
   • Health advice is often seen as generic, and hard to apply to individual life circumstances. Personalization offers users the feeling that the healthcare system is listening.
2. Support conversation around stigmatized and taboo topics
   • Shame comes up a lot in work around health behaviors, and people are quick to shut down if they aren’t met with nonjudgmental support.
3. Foster curiosity to combat information avoidance and fatalism
   • People have a tendency to avoid information that they believe to be threatening to their happiness and well-being, the threat of a disease they perceive as catastrophic key among those. Creating mechanisms for them to feel safe and explore new information encourages them to engage.
4. Provide concrete actions to help individuals navigate and manage their health.
   • People often describe their future health as something that feels out of their control. Providing individuals with smaller, concrete action steps helps support decision-making and restores a sense of agency.
5. Provide accessible expertise. Build confidence by increasing health knowledge.
   • Among high-risk populations, there is a knowledge gap about the availability and access of preventative options. Clear, accessible and explicit communication about the long-term benefits of early detection and the procedures available will help cultivate understanding and action among high risk individuals.
6. Be explicit about shared goals to break down skepticism and build trust.
   • We found that the fear of financial implications associated with a serious diagnosis, and an overall distrust around the hidden costs of healthcare, increases one’s hesitation to get screened for disease. Yet the benefits of early detection and this program overall is to catch cancer early in order to use less invasive treatment methods, consequently lowering costs for patients. Being transparent about these shared goals, but also potential risks, helps get people over that trust barriers.

Strategy

I worked closely with senior leadership at the hospital to make sure that as well as meeting the needs of users, concept for new products and services aligned with the strategic vision for the organization. Our team was heavily involved in setting the strategic vision for the program, socializing, and gaining buy in from leadership.

This vision was presented to senior leadership across the hospital in a series of research symposiums in the spring and summer of 2018.

In addition to setting a vision for the new initiative, I was responsible for guiding a plan to get us there. Changing a 100-year-old institution is hard, and balancing bold ideas and a path forward was a key part of keeping everyone moving forward.

Out of this strategic work, a few key areas were identified to prototype and pilot in detail. They included:

1. Creating a service design vision and plan of a new lung screening service, that incorporated digital tools to make the process as easy and seamless as possible.
2. Design and development of digital tools to be tested with our MSK Direct population, a program that serves large employers and has a vested interest in cancer prevention.

Service Design

The lung screening service was to be used as an first test ground towards implementing more sweeping changes in screening, and was chosen based on operational readiness, rich research opportunities, and a clear gap in user needs between people who should be getting lung screenings and those who actually followed through.

Our team organized a workshop in December of 2017 with doctors, nurses, researchers, technologists, and frontline staff to create and confirm a new vision for what the experience of what this service could be.

Based on interviews with end users and subject matter experts, we presented the group a vision of a lung screening service, that included outreach to at-risk individuals as well as personalized followup throughout the year.

The participants were then put into groups based on their subject matter expertise, and asked to map the answer to one question: How might we make this happen? Participants were given cards outlining different pieces of the service system in order to map process flows to support this new vision.

After the workshop we created a service blueprint for the implementation of the program, which was used to prioritize different areas of work.

At the end of this process, our team was tasked to build out and prototype digital tools that would act as guidance for users throughout this process.

Digital Product Design

The Prototypes

To launch our first prototypes, we partnered with an additional team in the institution: MSK Direct, a concierge service offered to large employers as part their employee benefits packages. They had become a testing ground for new ideas, and were excited to be the first to try out new digital tools in order to help increase screening rates.

Our first prototype text was a digital quiz, sent out with an email campaign around Lung Cancer Awareness month, to over 6,000 employees within the New York Area.

Functionality of the quiz was simple. A user clicked into the quiz and was able to answer 3-4 simple questions about themselves, which resulted in a customized results page giving them advice on whether they met the lung cancer screening guidelines, resources to quit smoking, information about lung health, and easy action steps to contact MSK if they needed more information. Language was non-judgemental, encouraging, and to-the-point. (As it was an early test to gage interest in the concept, it did not yet contain functionality to create an account or book an appointment online.)

Results were positive:

• 12% of those who received the email clicked through to the survey, relatively high when benchmarked against similar emails
• 91% of people who started the survey completed it
• 19 people were recommended screenings, and it resulted in 3 screening appointments scheduled.

Feedback from users and the employers was generally positive, though, as smoking rates are relatively low in the New York area, many wished for a tool that offered broader information. The resonated with some of our early research that suggested that people tend to think of prevention holistically, and want information about what they should do to prevent any cancer they might be at risk for.

A second prototype, this time focused on creating a comprehensive screening plan, was deployed in summer of 2018, to an employer with 68,000 employees across the US. It was also met with interest and positive reception, though feedback on its relevance to those outside the New York area forced us to reconsider how we presented this information to those not able to access care at an MSK location.

Planning for the Future

With the project’s merit proven, it’s been given the green-light to be developed further as a full product, initially targeted towards these large employers, and we’ve begun detailed product design. This work is still underway.

The new redesign of the screening action plan includes features to make the information clearer, more actionable, and transparent.

The new plans also include designs for a dashboard, enabling users to return, track their health and screenings over time, and set up action plans for positive health goals.

The next iteration of the digital experience is still under development, but set to be released in 2019. As one touchpoint in the larger service umbrella of care at MSK, it will continue to evolve as new care models are developed, and new research into what might prevent cancer is discovered.

Outcomes

The project has grown into several ongoing initiatives.

1. Service experience improvements are ongoing in both the lung screening services as well as within clinical genetics services
2. Digital outreach campaigns are being developed in collaboration with the marketing group at the hospital with our design principles in mind.
3. An initial use case of the full digital platform is being developed for MSK Direct partners & their employees, set to be released in 2019.
4. A second use case for the digital platform is being scoped with a new population use case in mind, those at risk for cancer for another reason, like genetics or viral disease.