Pharmacogenetics Project with Health Design Lab

Using design research methods to understand clinicians' attitudes and perspectives towards PGx and designing materials to improve education and application.

The project is part of the pharmacogenetics supercluster led by Telus Health, with GenXys, LifeLabs, and GenomeBC.
ABOUT
Digital Technology Supercluster project in collaboration with Emily Carr Health Design Lab, Telus Health, LifeLabs, GenXys, and Genome BC
TIMELINE
October 2019 - May 2020 (7 months)
ROLE
Researcher
Co-Design Facilitator
UX/UI Designer
TEAM
2 UX Designers
1 Project Supervisor
1 Emily Carr Faculty
challenges
What are the barriers and challenges for clinicians in implementing PGx?

How can we create design research methods and materials for the education of emerging technologies like PGx?
Problem Space
Currently, there is a significant pharmacological healthcare burden of identifying what drugs would be best for specific individuals based on their genetic make-up and reducing the incidence of adverse drug reactions and increase medication efficacy.

The application of pharmacogenetics could provide better medication decision support for pharmacists and primary care physicians.
Research
Our timeline for this project included 3 phases: secondary research and synthesis on pharmacogenetics, as well as physicians' and pharmacists' current attitudes, primary research and synthesis through a physical and digital workshop that can be reused by others, and a recommendation and user research report at the end.
Mapping To Understand Problem Space
Reading many scholarly articles on pharmacogenetics helped us learned there were actually multiple problem spaces and research gaps. This included evidence and utility, limited health professionals and patient knowledge, complex genetic reports, cost, and ethical concerns.

Altogether, the problem spaces were a really large scope and had to be narrowed further.
Pharmacogenetics Context Map
Narrowing Research Questions Within a Large Problem Space
We then refined our problem spaces had overlaps and used these to define our research questions. The questions on the map are arranged from the highest priority to a more specific and lower priority level.

problems spaces (arranged from the most important)
1.) Clinical Application
2.) Education & Awareness
3.) Evidence & Clinical Utility
4.) Ethical Concerns
Brainstorming/Mindmapping Research Questions Map
Mapping To Understand The User
Mapping allowed us to understand the daily tasks and pain points of the physician, as well as where design opportunities could be.

In addition, we made a context map specific to physicians to understand them as our primary users. We focused their problem spaces on the same spaces as the Brainstorming Research Questions Map.
Physicians Empathy Map
Physicians Context Map
Co-Design Session With GenomeBC
The Pharmacogenetics (PGx)  team at the Emily Carr Health Design Lab lead a co-design session with six participants from Genome BC at their offices on Friday, January 17th, 2020.

The goal of the session was to help us get a better understanding of what we want to learn from a workshop with physicians and pharmacists.
Pictured: Michelle and I

Understanding the Participants (Mini Personas)

This activity was to understand the users for our PGx project. The group filled out 3 mini personas (or user profiles) that help us think about the behaviors, the needs and goals, and the pain points of pharmacists, physicians, and patients.

Insights
We saw that pain points across the personas were often relational. These were different problems amongst each persona, but caused by a common and deeper issue. For example, a patient could receive information that they should take specific drug and result in having an adverse reaction because their variant was not in the system. The doctor could be blamed when the deeper issue was that the system was not updated.

There are more specific stakeholders that we need to be considering in our research, such as genetic counsellors and policy makers who could influence a large part of the implementation and education of PGx.

5W’s + 1H and Entity Positioning Map (Brainstorming Questions)

This activity was to get the participants to think of questions related to the pharmacogenetics workshop. We provided them with sections labeled, who, what, where, when, what and how. They then wrote down questions for each section on a post-it note. Many informative conversations and discussions derived from this process. Once the question sections were all filled out, we asked them to place the questions on the Entity Positioning Map. The y-axis is labeled “high priority” to “low priority”, and the x-axis is labeled “easy to answer” and “hard to answer”.

Co-Design Insights

Co-designing with GenomeBC was a good way to validate the research questions we had and guide the development of the workshop.

Summary of Entity Position Map with Common Themes Isolated

Theme of “Education”
Our participants placed a significant priority on the education of PGx in the Entity Positioning Map, which validated our primary research area. We learned that it will be necessary to consider different strategies for education of PGx to different ages. There is also room to research how physicians and pharmacists choose what they want to learn from their CME learning programs. In addition, the discussion brought up that it can be difficult for physicians and pharmacists to explain PGx to the patients and thus the responsibility should not all be on physicians and pharmacists to educate patients on PGx. Education was an area that was hardest to answer for participants on the Entity Positioning Map.

Theme of “Evidence”
The Entity Positioning Map showed that a significant portion of the questions involved the topic of “evidence”. It spanned across easy and hard to answer, and gathered mostly in the center of the map. However, the priority for these questions seemed to be in the middle. This helps us see that this could a grey area of knowledge for our participants and a significant theme to focus on for our workshop.

Solution A: Workshop Kit
The goal of the workshop was to learn about a clinician’s understanding of pharmacogenetics, what sources of information they find trustworthy, and how they see its application improving their clinical practice.
Activity 1: Empathy Study
A group activity about the physician’s perspective and understanding of PGx

Instructions
Participants anonymously answer the cards from their own perspective as a physician. Each card has prompts in relation to PGx and their practice.

Afterwards, they arrange them on the empathy canvas with tape, so that the same cards are grouped together in the same area.
Activity 2: Mapping Your Sources
A group activity about understanding what sources of information are trusted and accessed by physicians

Instructions
In pairs, the physicians brainstorm on sticky notes existing sources of information they access, considering their entire medical career: their education, their work, and etc.

Then they organize the same sticky notes onto an entity positioning map, comparing accessibility and trustworthiness.
Activity 3: Imagining the Future

A group activity that gets physicians to think about how they envision pharmacogenetics will impact their work and to determine if they find this practice valuable

Instructions
They work in groups to imagine the worst possible outcome of a future with PGx. Alternatively, they will also imagine an ideal future where PGx has been highly beneficial in different scenarios.
Probe Version

The findings from this workshop will be used to inform a separate workshop probe created for physicians to participate in the same activities remotely.

The workshop probe will be flexible and easy-to-use. Most activities can be done individually, but some will be encouraged to be done collaboratively with others if possible.
Designing in the Time of COVID-19
By the time our workshop with physicians was scheduled in March, gatherings across Canada were being cancelled due to the pandemic. However, the workshop we had designed could now be reused for other facilitators in the future.

Our next solution was to gather information remotely from physicians, in the form of a quick online survey.
Solution B: Online Survey
HDL Pharmacogenetics Study on Typeform
We used the questions we wanted to ask in the activities for the workshop as a foundation for the questions in this survey. Because this was an online survey, it had to be short and concise. We got rid of many questions about their personal practice and focused mainly on asking them about PGx. This was sent to physicians in an HDL newsletter.
Final Deliverable: Workshop Kit & User Research/
Recommendations Report
We will be using the insights from our survey, as well as the previous workshop and research maps to inform our final workshop kit and to write a user research and recommendations report. This will include a guideline on how to synthesize results from the survey (not just once, but over time) and how to reuse the tools/product.
Future Steps
Lessons Learned

(to be continued after end of project in May)