OPERATION PATIENT OUTCOMES
WHERE OUR JOURNEY BEGINS (PROJECT OVERVIEW)
In healthcare, it is often difficult to know how to help a patient best recover from a major surgery. Unfortunately, this is especially true in the case of tumor removal. A patient may go in for a craniotomy, and, although they can walk and talk afterwards, be unable to focus on the things they care about or the people they love. Across the country, a brain surgery is considered “successful” if a patient passes a series of basic motor and language tests. But everything else - including attention and memory - generally does not weigh in. This project wished to change that. Through our efforts, we hoped to give cancer patients a better quality of life.
Project Team - Researcher and Designer (Me), Design Teams, Development Teams, Surgery Teams, Research Teams, Information Technology Department
WHAT WE WANTED TO DISCOVER (PROJECT GOALS)
We wanted to develop a battery of tasks that could be used in the operation room during a wake craniotomy. We also wished to track patient performance on a series of language, attention, and memory tasks for up to 2 years post-operation.
We defined the following project goals:
Goal 1. Design a series of short tasks that could feasibly be performed by a patient during a wake craniotomy. Stimulated brain regions that led to sharp decreases in task performance would not be extracted, leaving the areas unaffected.
Goal 2. Test prototype tasks with patients and doctors and listen to their feedback. How are patients doing the tasks? Should we design a customized remote or controller for patients with limited mobility? Iterate until a finalized design is reached.
Goal 3. Track how patients perform a battery of tasks pre- and post-operation. How does performance correlate with quality of life and patient mortality post-operation?
OUR PLAN FOR SUCCESS (RESEARCH STRATEGY)
To succeed, we needed to orchestrate a finely-tuned collaboration across multiple hospitals and universities. As such, frequent communication amongst the research teams and surgeons was of paramount importance. We incorporated a variety of methods throughout the project, including the task measures themselves, interviews with doctors and patients, and in-person observations (contextual inquiry) across the different hospitals.
OUR MAIN CHALLENGE
We found out quickly that patients often had limited arm strength and mobility. To address this, we created a series of prototype controllers that would be easy for a patient to hold. The final product had an ergonomic design and could easily be used from a variety of sitting and laying positions.
HOW WE EXECUTED OUR STRATEGY (RESEARCH PROCESS)
We incorporated a mixed-methods approach involving computer tasks, interviews, contextual inquiry, and iterative analysis.
Task Battery
We created a battery of tasks that could be used inside and outside of the operation room. This often required creating applications that could be easily run on a laptop or tablet. Usability was critical. If a patient was unable to easily click a mouse or press a key on a keyboard, there needed to be another option available. Having this amount of flexibility also allowed us to perform longitudinal post-operation testing at the patient’s home.
Contextual Inquiry
Observing how patients performed the tasks was an important part in the development process. What issues did the patients encounter? Did they have difficulty understanding the instructions? Were they able to easily use the controller, keyboard, or mouse?
Interviews
Interviews were conducted with patients and doctors to provide immediate feedback. From these conversations, we were able to detect high-level emerging themes that helped guide the team’s direction.
Analysis
Throughout the entire process, we analyzed patient data to inform each iteration of the task battery development. We also analyzed data to track patients recovery post-operation. While performing these analyses, the question in the back of my mind was always “did the scores go up?” A higher score often meant the patient was recovering well, whereas a lower score indicated no improvement or decreased quality of life.
TOOLS WE USED
Tools – Multivariate Testing, Interviews, Contextual Inquiry, Prototyping, Iterating, Data Analysis
WHAT WE LEARNED (DISCOVERIES)
Insight 1: Patients preferred to use the ergonomic controller over other available options. They could easily hold it in whichever hand felt most comfortable for them, even when experiencing minor muscle tremors or arm weakness.
Insight 2: The timing of task stimuli was critical for the brain stimulation period. Signals needed to be sent out at particular intervals to let the surgeon know when to stimulate a given brain region during task performance.
Insight 3: At-home testing greatly increased patient comfort and data retention for longitudinal testing.
Insight 4: Longitudinal testing pre- and post-operation informed treatment plans for patients with similar cancer diagnoses.
THE IMPACT WE HAD
This project was truly one of the first of its kind. More than anything, it started a domino effect in the types of conversations doctors and surgeons began having in what defines patient outcomes and quality of life. The task battery we designed is currently being used in multiple hospitals across the nation, with longitudinal data continuing to help inform the future of patient healthcare.