Getting diagnosed with breast cancer can be a traumatic experience. In this research and design project, ethnographic methods were used to define opportunities for improving the delivery of care in one particularly difficult diagnostic procedure—stereotactic biopsy. Extensive observation and contextual inquiry with patients and clinicians helped shape the design of user-centered equipment, environmental, and interaction concepts addressing three main issues: promoting patient comfort, managing patient attention, and streamlining the process and environment. These solutions work in harmony to facilitate less traumatic diagnostic experiences, enabling patients to begin the journey through breast cancer with as positive an outlook as possible.

As a graduate thesis project, independent of any client or initiative, this project’s scope was virtually infinite. Unconstrained by the core competencies of a device company or the agenda of a healthcare provider, I was afforded the freedom to explore the problem holistically and conceptualize solutions for disparate stakeholders, including hospitals and the manufacturers of multiple types of equipment and devices. My goal was simply to contribute qualitative research data and design concepts to the collective efforts aimed at improving healthcare patient experiences. In broad terms, I sought to address the question: How can the experience of being screened for and diagnosed with breast cancer be improved through design intervention?

As a designer and a woman with a family history of breast cancer, I was interested in applying user-centered design methodologies to address a less-than-ideal human experience truly worth improving. Through early immersive research, which included shadowing clinicians at breast care facilities, observing a number of screening and diagnostic procedures, and interviewing breast cancer patients and survivors, I recognized one specific procedure—stereotactic breast biopsy (SBB)—as particularly difficult for patients. An SBB patient must lie prone on a table, her breast suspended through an opening and placed in compression paddles for 30-60 minutes while the suspicious area is isolated via x-ray imaging and tissue samples are removed through a large core needle. Because the needle is clamped in a stationary position, it is crucial that the patient remains calm and completely still to minimize tissue damage, bleeding, procedure time, and radiation exposure. Given what I had observed and learned about its nuances, I chose to further explore SBB, narrowing my research focus to address four questions as the starting point for design:

1. What is the current experience for women undergoing SBB and which elements make it so traumatic?

2. How does the team of clinicians work together to deliver care and what effect do their roles and protocols have on the patient’s experience?

3. How do the equipment and environment contribute to the patient experience?

4. What are the implications for the patient’s biopsy experience beyond the immediate impact of the procedure?

I used ethnographic research methods to analyze the procedure from all relevant perspectives—contextual interviews with clinicians to establish a foundational understanding of goals, motivations, protocols, and frustrations from the clinical side; interviews with women before, during, and immediately following biopsies to understand the patient perspective throughout each stage. Patients completed an emotion-charting exercise, evaluating their feelings at key points to assess when and where physical and emotional comfort is needed. I used visual mapping techniques to plot the movement patterns of each user and to analyze the environment and equipment for efficiency and comfort. Coding of audio recordings informed detailed procedure timelines that distilled the process down to each task and movement.

The research was rigorous in its depth regarding the number of biopsy procedures observed (12), facilities consulted, and clinicians and patients encountered. The target audience for the project included all users involved with SBB—clinicians, hospital administrators, and breast care patients. On the clinician side, the procedure is typically administered by three medical professionals—a radiologist, an x-ray technologist, and a nurse. Participants in this research included six radiologists, five facility administrators, three nurses, 11 x-ray techs, and 16 biopsy patients across seven facilities in Illinois, Indiana, Ohio, and California. All were interviewed and/or observed in this research, and select clinicians participated in co-creation.

The research was comprehensive in its breadth regarding the spectrum of adjacent procedures and touch points observed and analyzed relative to the patient journey of breast cancer diagnosis—everything from patient consultations and screening mammograms (which I underwent myself, documented, and analyzed as an immersive exercise) to ultrasounds and a variety of biopsy procedure types. This breadth provided a rich understanding of the context around the SBB procedure and established empathy for the patient’s experience. Generative research laid the foundation for the development of conceptual design solutions, providing insights and guiding design principles for brainstorming. Frequent check-ins with clinicians throughout analysis and synthesis provided assurance of the validity of the research, while co-creation sessions were used to build on and refine concepts.

As a conceptual project with no client, theoretical stakeholders included equipment manufacturers and hospitals. For the equipment manufacturer, I considered the opportunity for differentiation through user-centered design solutions boasting greater efficiency and patient comfort. For hospitals, in addition to procedure efficiency and quality of care, the most significant area of interest I considered was the facilitation of positive patient experiences. Diagnosis is a crucial evaluative time for a patient, where she begins to form an attitude not only about her medical situation, but about her care team and the hospital itself. Sometimes referred to as the “front porch of cure programs,” (Veldhoen, 2006) centers for screening and diagnostics serve as not only an essential medical service, but also a marketing vehicle for the hospital at large. When a patient has a positive diagnostic experience, she is more likely to return to the same hospital for future medical care or to seek care early as issues arise.

This research and design project illustrates a holistic approach to healthcare design that is patient centered, ethnographic research driven, and experience shaping. The work demonstrates how design thinking can be used to improve the human experience by reducing the physical and psychological impact of potentially traumatic medical procedures. This type of endeavor carries implications both for the delivery of healthcare as well as the practice of design.

As the American healthcare industry adapts to the changing political, economic and social climate of the 21st century, the patient’s shift from passive recipient to discerning consumer of care will continue to alter the industry’s approach, raising the stakes for providers. Hospitals and related services must continue to innovate to attract and retain customers seeking not only positive health outcomes but also positive experiences. As demonstrated here, this innovation can be achieved by applying human-centered design strategies toward the improvement of the equipment, instruments, environments, communication media and systems that constitute the product that is healthcare. Conceptual solutions for multiple touch points necessitates applying the all-inclusive practice of Design (with a capital D), whereby multiple design disciplines—from industrial, graphic, interior, interaction, and apparel design—collaborate to create positive patient experiences. Thus, this work represents Design’s potential to contribute to the discovery and materialization of innovative solutions to problems in the delivery of healthcare.

Although I set out to improve the patient experience simply because it seemed ripe for improvement and people deserve to be as comfortable as possible when receiving medical care, I quickly realized that addressing the SBB patient’s comfort is important, not only for her immediate experience of the procedure, but also in how it impacts her outcome and the process itself. In the immediate sense, holding the required prone, compressed position is uncomfortable and sometimes painful in itself. Discomfort can also lead to patient movement, which can result in increased bleeding, torn incisions, greater healing time, and unnecessary radiation exposure from additional x-raying. Patients often miscommunicate to clinicians, failing to express how uncomfortable they are initially, and later feeling guilty for needing to readjust.

Additionally, because she is awake throughout the entire procedure, the patient plays a crucial role. She must remain completely still, avoiding reactions to potentially jarring sounds and uncomfortable physical sensations. For this to be possible, the patient must work with clinicians to make her comfortable enough so she will not fidget and she must remain engaged enough to avoid being caught off guard when the needle is inserted (which is accompanied by a loud snapping sound). Therefore, managing patients’ attention and engagement in the procedure is critical to successful outcomes. Thus, the tactical goal of my research and design effort shifted from figuring out how to make the patient comfortable to empowering the patient to play an active role in the delivery of her care.