Understanding the unique challenges along their journeys.

We employed human-centered design methods of interviews and contextual inquiry to understand the experiences and challenges of multiple stakeholders (patients, behavioral health providers, medical providers, site program administrators).

Both the cancer care journey and the psychosocial care journey were alone limiting in characterizing the challenges of patients with cancer and depression, in part because the combination of the two journeys further complicate the patient experience by exacerbating the characteristic challenges of each of them.

To address this limitation, we developed the concept of a parallel journeys framework as a conceptual design framework to examine these journeys together and to help organize our data.

Assessment.

Patients with cancer and depression often struggle to make regular behavioral health care appointments, but regularly assessing the progression of depression can be helpful for care manager follow-up and for adjusting treatment plans. We need to provide tools for and around self-assessments for patients to check in on their own terms.

Monitoring.

Patients often fall through the cracks in the midst of everything that they need to deal with. We need to provide tools for population-based patient monitoring to ensure that at-risk patients are identified before escalation.

Intervention.

Traditional psychotherapy as-is may not apply to these patients because of frequent changes to stressors and treatments. If they are too nauseous from chemotherapy, they cannot make it to their next therapy session. We need to provice access to digitally-translated, evidence-based psychosocial interventions and flexible treatment modalities.

Documentation.

Patients with cancer often experience a “chemo brain” or reduced cognitive function due to extreme stress or cocktail of medications. Often the output of therapy sessions are not well documented which makes seamless continuation of the treatment difficult. We need tools for documenting shared understanding that both patients and providers can access.

Engaging the patients.

For patients with cancer and depression, staying engaged in depression care is difficult on top of their already over-burdening cancer care. Unlike traditional behavioral health care, patients with cancer need a new and innovative delivery of psychosocial care that works on their schedule, according to their needs, and wherever they happen to be.

We have an opportunity to reinforces the value of behavioral health care by enabling “closing of the loop” from session to session and helping both patients and providers review and see progress and stay focused on the treatments. 

To make this successful, there are four main touchpoints for technology we need to look at:

• In the Record touch point, patients and providers document values, goals, activities and follow up.  

• In the Engage touch point, patients actively engage in care where they executes the plan and track progress.

• In the Monitor touch point, providers monitor progress and prompt follow ups.

• In the Review touch point, patients and providers review progress and adjust treatment plan.

• Between the sessions, patients and providers stay in touch through communication.

Keeping these in mind, we are developing technology tools to help patients stay engaged in their care and to help providers keep healthy tabs on them to improve their depression care outcomes.