Exploring Polypharmacy: A Storytelling-Based Co-Design Approach to Creating Patient-Centered Solutions

Problem

Current health policy calls on primary care clinicians to conduct structured medication reviews to address polypharmacy, with a particular focus on problematic or ‘higher risk’ polypharmacy (e.g. the prescription of 10+ medications).

Approach

We used a co-design approach, the Storytelling Group technique, to re-imagine the medication review and its potential for addressing polypharmacy. Three workshops were facilitated by a design researcher, two qualitative researchers, and a live illustrator. They involved seven participants (aged 65+), all interested in reducing the medication burden for older adults. Participants engaged in collaborative fictional scenario-building, drawing on their lived experience of polypharmacy. They created characters, timelines, contexts and plots. Facilitators aided story development by introducing provocative ‘what if?’ prompts, based on insights from their wider ethnographic study of polypharmacy.

Findings

Six fictional character profiles were created. Descriptors included age, gender, ethnicity, occupation, residence, and multiple long-term conditions. Participants constructed rich and imaginative narratives about healthcare interactions with different professionals in different contexts. Given the remit of the co-design project, we anticipated storylines would conclude (at least in some instances) with characters positively addressing polypharmacy, thus opening up ideas for service re-design and interventions that might be evaluated in practice. Despite participants’ investment in reducing medication burden and their enthusiastic engagement with the Group Storytelling approach, none of the narratives they co-constructed involved the successful reduction of medications. Participants displayed a wide range of assumptions concerning the roles occupied by health professionals and the complexities of relationships between patients, clinicians and medicines and the health system at large. They had difficulty imagining the possibility of addressing polypharmacy, even within a deliberate speculative exercise designed to loosen them from any attachments to conventional logics of medical care.

Consequences

Polypharmacy is a ‘wicked’ problem with no ‘quick fix’. Tackling it is likely to require a multifaceted approach and collaboration involving healthcare professionals, patients, caregivers and information providers. Our work provides insights into the strengths and limitations of co-design when the phenomenon being examined is sufficiently complex as to escape articulation. We have collated insights from our ethnographic research and reflections on Group Storytelling to curate a series of seven fictional short stories, collectively known as "Let's Talk Differently About Medicines". This is a patient-centred tool, including stories that range from the highly plausible to the highly speculative. We invite readers to consider how patients and professionals are positioned within the health system, reflect on normative assumptions, recognise emotive responses, identify care priorities, grapple with paradox and explore possibilities for change. Most of all we hope that it will cultivate courage amongst patients and clinicians to talk about a topic that our research shows is very difficult to talk about.