Navio's Med Checklist

The Opportunity

Over the past two decades, oral oncology therapies have boomed. Instead of going into a clinic and sitting in a chair for hours to receive chemotherapy, patients can take medications at home.

With convenience comes new challenges. Now, patients must remember medications at the right time and know how they should be taken (dosage, with or without food, etc.) at multiple times throughout the day.

Study after study has shown that adherence to oral medications is surprisingly low, leading to decreased medication efficacy, disease progression, increased hospitalizations, and even death. Taken together, the cost of non-adherence in cancer has been estimated at ~$70,000 to ~$160,000 per person.

Contributing factors of non-adherence include:

• Lack of knowledge or experience at treatment start
• Memory and forgetting
• Side effects
• Complex and dynamic treatment schedules
• Cost

Talking to Patients & Caregivers

From past conversations, we knew that caregivers played a key role in managing brain cancer treatment due to the mental and physical challenges patients face.

At the same time, we planned to expand Navio's support outside of brain cancer, so we decided to talk with patients and caregivers across various diagnoses about how they manage their medications.

We learned about common tactics that people use, such as a physical checklist, filling a shot glass with pills for later, pillboxes, and setting an alarm on a phone.

Despite having all of these solutions, patients and caregivers still reported difficulty remembering to take medications and they often forgot if they'd taken an earlier dose.

Objective

We were confident that we could leverage our knowledge of cancer treatment and our flexible treatment calendar to better serve patients during active treatment. Our objective was to...

Lightning Demos & Sketching

I was excited to have my friend and colleague from Vim, Tammy, as the lead designer on this feature. We started by sharing lightning demos of existing medication and task management apps. Tammy also tested a few out and shared her observations with me. Then we did some sketching and discussed ideas for the design.

Prototyping & Testing

We created an interactive prototype and tested task-based scenarios with patients and caregivers. We asked participants to:

• Mark a single medication as taken
• Mark a group of medications as taken
• Mark a medication as skipped and log a reason for skipping
• Navigate between days

I wanted to share our learnings with the broader Navio team in our next all hands meeting. In order to help my colleagues empathize with users, I sketched a few personas based on our participants.

Key take aways from our user feedback:

• There's too much dense information, it feels overwhelming
• Text is too small
• Generally, it needs to be simplified, especially for people who may have cognitive difficulties
• Most people would just check off the current medication, not look ahead
• People wouldn't log skipping, nor did they care to enter a reason (only if a doctor told them to do it)
• The act of checking something off feels good, like you've accomplished something (even if a small thing)
• Getting a reminder could be very helpful
• Reminders via SMS felt important and less likely to be ignored than an alarm or push notification
• It could be helpful to refer back to earlier meds to confirm that they were taken, but only from the current day

Design Iteration

After testing with cancer patients and caregivers, we also did some internal stakeholder interviews to gather feedback. It became clear that we needed to do a few things in our next iteration:

• Simplify the layout—Make each view less dense, focus on one thing at a time (current med to check off, current day).
• Make everything bigger—Enlarge font sizes, make icons and imagery larger.
• Descope functionality—No need for skipping, logging reasons, etc. Focus on what needs to be done right now.
• Make it more delightful—Navio's design approach incorporates moments of delight and personality where appropriate. We would look for opportunities to inject a little joy into an otherwise tedious task.

Tammy and I challenged ourselves to "subtract until it breaks", which is a principle I always go back to.

Working together at Vim, I saw what a great illustrator she was. I asked if she could grab some elements from the journey illustrations I created and think about how she could expand on those concepts here.

Our next round of designs were more focussed, simple, and visually compelling.

We tested these designs with some of the participants from our first round. They found it easy to understand and liked how quickly they could take the action of checking off medications.

We also reviewed with internal stakeholders and made some adjustments before preparing the hand off to engineering.

Hand Off to Engineering

Once we'd completed the discovery and design phases, we were ready to prepare for hand off.

This is a crucial step in the design process. Not only does it help ensure that all of the little details are understood and implemented, but it also shows that you're a good partner to those who are responsible for implementing your designs.

We made sure to show all of the various states of the app and UI components, make notes about transitions and interactions, and prepare graphic assets so that they're optimized for export.

Implementation & QA

There are always questions during the implementation process, and frankly, things that we missed in the design spec. Tammy and I addressed questions as they came up, mostly over Slack.

We also put together a QA checklist and ran through task-based scenarios on staging several times, logging issues in Jira.