by Tim Tedeschi, University of Cincinnati

Ann Brown, left, reviews imaging data with a patient. Credit: UC Health

When you order a pizza, an online tracker can provide real-time data that lets you know when your pizza enters the oven, is boxed and is then on the way to your house.

But for patients waiting for results and next steps after a mammogram, the process is not always so transparent.

A multidisciplinary team from the University of Cincinnati's Colleges of Medicine and Design, Architecture, Art and Planning (DAAP), the Live Well Collaborative, and GE Healthcare took a human-centered design (HCD) approach to identify and implement tangible patient-centered improvements in the screening mammography program.

The team published a case study of their work and findings in the Journal of the American College of Radiology.

Getting started

HCD is a design framework that starts with the end user's needs, thoughts and behaviors in mind and keeps these insights as the focus throughout the design process. The project was part of a larger initiative supported by GE Healthcare and the American College of Radiology Innovation Fund seeking to improve patient-centered delivery of care in radiology.

"The goal was to address the challenges patients often face in understanding their scan results, especially in mammography, where clear communication can significantly impact patient experience and decision-making," said Cecilia Xi Wang, Ph.D., assistant professor at the University of Minnesota College of Design, who worked on the project as a postdoctoral researcher at UC.

Ann Brown, MD, associate professor of radiology at the UC College of Medicine and a UC Health breast radiologist, noted mammography was identified as an area ripe for the HCD approach due to radiologists already playing a large role in the screening, diagnosis, biopsy and referral process.

"We had seen this as something that we know is anxiety-provoking for women," said Brown. "We found we do very well in terms of sending reminders but not so well in terms of what are the next steps for patients."

Research details

Through observation and in-depth interviews, the research team—made up of radiologists, UC Health operational staff, technologists, coordinators, and design faculty and students—began the HCD process by identifying patient pain points through mammogram scheduling, appointments, and results and follow-up.

Wang conducted research to better understand patient needs and preferences for mammography reports, with a focus on content clarity, visual presentation and ease of access.

"My work was critical to mapping the information gaps from multiple perspectives—patients, referring physicians and radiologists," Wang said. "This approach was about simplifying the data and ensuring that every patient, regardless of background, had the tools to participate in their health care decisions actively."

The team identified four key patient needs:

• Reducing waiting time for abnormal screening results, a major source of patient anxiety

• Making reporting clearer as to whether results are likely benign or malignant, along with next steps

• Presenting results with humanized language

• Improving awareness of breast density and its implications

From there, they brainstormed and designed support tools to address these issues. Much of the work focused on improving or adding features to patient dashboards on MyChart, the online platform where patients can schedule appointments, message their providers and view test results.

"One of the biggest things we focused on was how we're utilizing technology, since people are now relying on their devices and accessing their health care information using the online MyChart tools," Brown said. "With the release of patients now being able to read their own reports, we realized we need to have a better system whereby patients can understand those reports."

Wang noted it was important for the complex medical information to be presented in a way that is both accessible and comprehensible for patients. Analogous to pizza delivery trackers, the process tracker the team designed will allow patients to receive real-time updates when images are reviewed, finalized and expected to be available to them, and they are working to implement the tracker in MyChart.

Previous standard mammogram reports included written explanations of a patient's breast density, but the team added images to help visualize what each type of density means.

"It has four categories, but it doesn't mean much of anything to just have the wording, the jargon," Brown said. "It means more to have a representative image behind it to see what is the scale and then which one are you of the four categories."

After identifying that follow-up letters sometimes came across as cold and clinical, the collaborators additionally revamped the standard letter to include more approachable language.

"Simplifying the information into lay terms and explaining what's actionable from it was an important component," said Seetharam Chadalavada, MD, associate professor and vice chair of radiology at UC's College of Medicine and a UC Health radiologist. "We added language into the letter to demonstrate that we care about your well-being, here's the recommendation and here's how you get a hold of us."

Chadalavada said he had never participated in a project utilizing HCD before, but he was excited to step out of traditional silos where physicians and design experts don't usually work together.

"Industry has been amazing at using human-centered design, but medicine tends to be a little more traditional," he said. "Oftentimes we rely on, 'I'm the expert, let me tell you what you should do.' But we kept the end users in mind when going through this process."

Wang said her experience on the project reinforced her belief in the importance of effective, user-centric design to empower patients, and she has continued to work on multidisciplinary teams to bring design thinking to health care settings in her role at Minnesota.

This includes a project using artificial intelligence to enhance medical education information and a project developing an interactive design tool to help connect students and physicians interested in joining Minnesota's Rural Physician Associate Program.

"These experiences have emphasized the importance of creating tools and systems that are not only technically sound but also user-focused, ensuring they address the real needs of the individuals and communities they are meant to serve," Wang said.

"The skills I developed in facilitating communication across different disciplines and implementing HCD principles have been crucial in my ongoing work, allowing me to navigate these complex, impactful initiatives effectively."

Brown said the plan is to continue to add more tools the team identified but has not been able to yet implement, including more engaging and user-friendly patient education resources within MyChart. Additional tools provide as much information and context as possible and help alleviate patient anxiety.

"We want our patients to feel empowered to ask questions and to really understand their own health, and it certainly helps to have all of that information in a very simple and easy to access place where it's not all spread out," Brown said.

"We want to be a source to be accurate, accessible and personable so that we can empower our patients," Chadalavada added. "And empowering the patient also bridges and strengthens my relationship with the patient as a consulting physician. You're together, as opposed to directing them or redirecting or guiding. Especially with breast cancer, you're walking the journey together."

More information: Seetharam C. Chadalavada et al, Humanized Health Care: Human-Centered Design in Screening Mammography, Journal of the American College of Radiology (2024). DOI: 10.1016/j.jacr.2023.11.027

Journal information: Journal of the American College of Radiology 

Provided by University of Cincinnati