Background Drug administration by self-injection is often an option to treat chronic diseases. This treatment option can be emotionally and physically demanding for patients (pts).1
Objectives To use a holistic approach to identify common themes both along the treatment pathway (ie. from diagnosis and throughout treatment), and at the moment of self-injection that, if changed, have potential to improve pt experience and treatment outcomes.
Methods Two ethnographic research projects were designed and conducted: Field Insights CODE (FI[CODE]) provided an overview of the treatment pathway and Injection Mission 2020 (IM2020) focused on the moment of self-injection. FI(CODE) consisted of individual and group interviews investigating the treatment process from a pt and healthcare professional (HCP) perspective. It used an open ethnographic approach (no set questions/discussion guides) to avoid restricting the feedback obtained. Interviews were conducted in San Francisco, Chicago, London and Manchester, with 10 HCPs and 58 pts (8 pts in-home and 50 pts over 12 focus groups). IM2020 consisted of a review of over 50 UCB Pharma injection device design internal information sources, and expert interviews aiming to understand how injection devices affect individuals. Interviews were conducted in San Francisco, London, Boston, Atlanta, New York, Toronto and Tokyo with 10 pts, 7 HCPs and 5 medical device design experts.
Results FI(CODE) interviews identified common problems encountered along the treatment pathway that could increase treatment failure rates (Figure). Pts with more treatment options and greater disease understanding through education were less likely to struggle with the treatment process. Pt treatment choice was limited by the healthcare system (ie. institutional guidelines, reimbursement restrictions) and the method of device selection; specifically, pre-selection by doctors and nurses reduced the number of device options for the pt. By focusing closely on the moment of self-injection, IM2020 demonstrated that pts who developed an effective, personalized injection process had greater levels of success with self-injection. Five tightly linked components that influence the injection experience were identified: delivery process, emotional state, social perception, educational level and ritualized development. Pts who successfully mastered all 5 of these were more likely to succeed at self-injection.
Conclusions By examining the pt treatment journey in a novel way, FI(CODE) and IM2020 identified common problems along the treatment pathway, advancing our understanding to help improve pt treatment experience. Small changes that improve pt education and increase choice at the start of the treatment process were identified as key to improving treatment success rates. Pt education should aim to help pts understand their disease and develop an optimum personalized self-injection process.
Cox D. J Neurosci Nurs 2006;38:167–71
Acknowledgement The authors acknowledge Costello Medical Consulting, funded by UCB Pharma, for writing and editorial assistance.
Disclosure of Interest M. Schiff Grant/research support from: UCB Pharma, Consultant for: UCB Pharma, M. Aris Consultant for: AbbVie, BSRBR and UCB Pharma, Speakers bureau: Bristol-Myers Squibb and Chugai, S. Saunderson Consultant for: UCB Pharma, I. Mountian Employee of: UCB Pharma, P. Hartley Consultant for: UCB Pharma