Pain Point: Improving Pain Management Through Human Behavior and Technology
My Role
This project was completed during a Human Behavior and UX class in the HCI Master of Science program at DePaul University. I made the following contributions to this project:
Conducted secondary research about pain management medications
Created the word association exercise and journey map exercise, which were used as interview warmup tools
Contributed to the stakeholder and patient discussion guides
Recruited medical practitioner stakeholders and long term pain management patients for interviews
Conducted two stakeholder interviews
Created the behavioral archetype
Identified areas of growth mindset
Designed the analog prototype
Problem Area and Target Audience
Our team recognized the need to encourage a more holistic approach to pain management. We believed this would reduce patients’ dependency on pain medications for relief, and could potentially reduce instances of opioid addiction. We asked ourselves,
“How can we encourage increased awareness about pain management options, and help patients advocate for themselves as they interact with healthcare professionals to manage their pain?”
We identified adults who had recently sought or were currently seeking pain management assistance as our target audience.
Hypotheses
We initially created three hypotheses, which we refined throughout our research process. Though our initial focus was exclusively on pain management patients, we wrote two final hypotheses that consider the patients and pain management practitioners. Our stakeholder interviews revealed that improved pain management was mutually beneficial to both parties.
Hypothesis 1
With more awareness and insights regarding pain management, patients will engage with their practitioners more, and take greater responsibility for their health outside of pain management appointments.
Hypothesis 2
Better communication between practitioners and patients about their pain will lead to patients and practitioners being more satisfied with pain management results.
Methods
Each person on our five person team conducted two remote Zoom interviews with pain management patients or practitioners to help us better understand their challenges and needs around pain management. We created two different interview warmup tools for patients and practitioners. For patients, we provided a journey map to fill out and for physicians we asked them to do a word association exercise that focused on pain management (see images below).
We wrote two separate discussion guides for patients and practitioners. In patient interviews, we asked questions about how they confronted their pain management, and their experiences with health practitioners. In practitioner interviews, we asked questions about how they worked with patients to manage pain, and explored the challenges they face, their recommendations, and thoughts about patient and practitioner communication.
Participants
Pain Management Patients
We interviewed five patients who had managed non-terminal chronic or persistent pain lasting one month or longer within the last five years. We required that they had have consulted with a medical practitioner about their pain.
5 patients
4 female, 1 male
Ages 30 - 78
Pain Management Practitioners
We interviewed five Allopathic and alternative pain management practitioners who offer patients pain management guidance or treat pain.
5 practitioners
1 Pain Clinic Manager/Nurse
1 Chiropractor
1 Acupuncturist
1 MD, Internal Medicine
1 Medical Resident
3 female, 2 male
Ages 26 - 75
Findings
1. Mental health and emotions affect pain and how it is managed.
“When you have that dull pain or a sharp pain that's steady, I found out through this process that it actually is very common for depression. So like, I am a person that’s like a pretty cheery guy, so for me to have down and negative thoughts two years into [the pain management] process, I thought something was really wrong with me. And doing some work with doctors, I found out that two years plus of constant pain is when depression starts to set in, because your body, your mind gets used to it, but it's still attacking your thoughts.” - Steve, Patient
2. Practitioners need to understand the whole patient picture, because this affects the course of pain treatment.
“So again, just really, you know, getting to know them, getting to know what [patients’] expectations are, letting them know what you can do. Some people just really want to come in and talk to you, see what you can do, and then go home and think about it for a while. So what is it that we can leave them with to let them know that we can help them if we think we can?”
- Mary, Pain Clinic Manager & Nurse
3. The patient and practitioner relationship requires good communication from both parties, to build trust and understanding.
“It's not being afraid to ask questions. I think a lot of us have problems with not wanting to look dumb, but just because we don't know something doesn't mean we're dumb. We haven't had the opportunity to explore the subject. So, going in [to an appointment] and writing down some questions that you have, and then while there, you can also take notes. Seeing if the practitioner is open to you contacting them in some way before the next appointment, in case you have questions. When it comes to healing, you want to be comfortable with the professional in front of you.” - Libbey, Acupuncturist
4. Both patients and practitioners encounter barriers that prevent ideal pain management within the healthcare system.
“I spend a lot of time, because I won't work unless they give me time. Usually you get half an hour in between the computer and everything else. And the mandatory things you have to ask, you ended up working till midnight at night to finish everything.” - Cathy, Internal Medicine MD
5. Pain management is a process, and most of that takes place outside of meeting with a pain management practitioner.
“If this patient has this condition, and I need them to come in three times a week, and they're only coming once and they're telling me they're not getting better? ...You've got to be coming three times a week, so we can get this under control. You've not been compliant with the care. If your dietitian tells you, you need to cut down 1000 calories a day, if you're not cutting down 1000 calories, you're not going to get those outcomes that they need you to get. You want to find improvement to find relief.”
-Raj, Chiropractor
Behavioral Archetype
We used our interview analysis to inform Terri, our primary behavioral archetype. We choose to focus on the chronic or long-term pain sufferer, because we felt that this archetype had the most areas of opportunity. Terri is our chronic pain patient archetype, and she experiences a number of touch points and changes in her pain symptoms and pain interventions over time. Because Terri has significant experience managing her pain and has seen successes, she is more invested in her short and long-term pain management than patients who do not experience long term pain.
Journey Map
Terri’s journey shows multiple influencers, including different medical practitioners and one of Terri’s friends. We felt it was important to show Terri’s interactions with multiple pain management practitioners and treatment methods, to highlight that chronic pain is a process with many touch points. Some of the barriers that Terri experiences are directly related to her own actions, and these can be reduced or eliminated if Terri implements certain lifestyle changes.
Goals
We established and prioritized our goals after we created the archetype and journey map.
Create a patient-centered tool that improves their communication with pain management practitioners
Empower the patient to better understand their pain by recording important details of their pain journey
Promote a proactive lifestyle that encourages the patient to take control of their pain
Design an interface that helps the patient quickly and easily recall successful and unsuccessful pain management interventions
Target Behavior
We focused on two target behaviors we wanted the product to positively affect:
Encourage the patient to track their pain levels, and all pertinent information daily.
This creates better self-awareness, and helps the patient see patterns regarding:
Causes of flare ups
Successful interventions
Unsuccessful interventions
Improve communication between the patient and practitioner
This creates better self-awareness, and helps the patient see patterns regarding:
Helps the patient recall important details and and accurately articulate pain management records to their practitioner
Improves self-efficacy by giving the patient a sense of confidence and control
Decision Levers
We identified five decision levers that we could potentially utilize to encourage users to adopt a pain management tool, and use it consistently.
Benefit Versus Loss
The time and effort that the patient puts into managing their pain versus the payoff of feeling better and participating in the activities can’t do during a flare up.
Self-Efficacy
Patient confidence will increase when the patient:
Can more accurately communicate details of their pain to their practitioner
Shares feelings about their progress
Feels better prepared to ask helpful questions
Self-Image
The actions that the patient takes will directly influence their self-image
There is a cyclical relationship between how a patient feels about themselves and their motivation to help themselves
A positive self-image could help promote physical and mental health
Behavior Reinforcement
Informative notifications can:
Motivate the patient to regularly participate in preventative care that may help them avoid a pain flare up by highlighting progress
Warn the patient about the dangers of neglecting preventative care, with a “nudge” to inspire them keep tracking
Social Proof
Influence and reinforcement from:
Social networks help encourage the patient to keep up with their routine and validate a chosen intervention
Practitioners’ feedback and input encourages the patient to regularly use the app
Dynamic integration with other health apps may increase the app’s worth to the user
Design Strategy
We first identified the stages in our users’ journey where we believed we had opportunities to impact their behavior.
Then we created a design strategy map that showed each of the journey stages, decision levers, and areas of opportunity. This helped us narrow our focus to the stages we felt we could most easily affect, and make the greatest impact. We decided to design for stage 2, when the user is having a pain flare-up, because this would help the patient easily and accurately record details about pain and activities associated with a flare up. We also concentrated on stage 4, when the patient is visiting his or her pain management practitioner, because this would help the patient accurately recall the details of their flare up, share this information with their practitioner, and ask useful questions about pain management.
Competitive Analysis
We conducted a high level competitive analysis of pain management apps to help inform our prototype. Three of them stood out for their unique approaches to pain management: Curable, PainScale, and Manage My Pain. Our analysis showed several interesting features that we integrated into our existing prototypes, and others that are worth considering for future versions.
Design Objectives and Implications
Once we understood our users’ goals, and identified the potential decision levers, we brainstormed potential design objectives and implications. We wanted to create a digital and analog version of our product, so that it would be accessible to users of all technology levels.
We identified two primary objectives for our initial prototype. We wanted it to serve as a pain management tracking tool, and a communication aid between patients and pain management practitioners.
The prototype would be used to track:
Date and time of pain flare ups
Intensity of pain
Location of pain
Pain trends
Activities and events associated with flare ups
Interventions used
The prototype would improve patient and practitioner communication by:
Providing a way for patients to quickly reference their records of pain and interventions they used to alleviate it
Making it easier for patients to easily share details of their pain with pain management practitioners and caregivers through digital and analog means
Allowing patients to scan and organize informational documents and exercise instructions provided by their practitioner to help them manage their pain
We also felt that it was important to implement a reminder function for our digital pain tracking tool, to encourage regular use.
The Prototypes
App Prototype
We created an app that acts as a digital pain journal to simplify the process of patients communicating their pain details with pain management practitioners. We felt that it was particularly important to create an easy to use interface that allows users to quickly record details of their pain, and reference them later.
Analog Prototype
Based on our interviews with pain management practitioners and patients, we felt it was important to include an analog prototype option, in addition to the app. This would provide options to users with different levels of tech literacy, comfort and availability. We also believed an analog pain management tool would be more accessible to caretakers.
Future Considerations
This project was concluded in just ten weeks, which pushed our team to prioritize our workload and provide what we believe are the most complete results we could share in this short time frame. If we were to continue this project, we would like to:
Research the desirability of the notification system, especially around the frequency and type of reminders and notifications used.
Conduct usability testing on both prototypes, and refine prototypes accordingly.
Hold a co-design workshop with patients and practitioners to improve prototype designs.
Explore the feasibility of Pain Point’s integration into a pain clinic practice, and eventually larger health systems.