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Designing Compassion into Asynchronous Messaging in Primary Care: Findings from Co-Creation Workshops
ABSTRACT
Background:
Asynchronous messaging (AM), including patient messages, lab results, specialist correspondence, and internal team communications, is now routine in primary care, offering patients timely access while reducing the need for in-person visits. However, AM has generated substantial workload and is thought to contribute to clinician burnout. Despite its increasing role in primary care, limited empirical work has examined how AM can be intentionally designed to sustainably support compassionate relational care.
Objective:
This study aimed to co-design compassionate and sustainable approaches to asynchronous electronic messaging in primary care by engaging patients, clinicians, clinic staff, and health system leaders in identifying challenges and developing feasible solutions for communication workflows, standards, and platform design.
Methods:
We conducted sequential co-creation workshops between June 2025 and January 2026 as part of a multi-phase, design-led qualitative study. Separate workshops were held with (i) patients; (ii) medical office assistants, nurses, and staff; and (iii) family physicians; followed by (iv) a final multi-stakeholder workshop including patients, clinicians, health system leaders, and digital health stakeholders. Workshops built on prior ethnographic observations and semi-structured interviews across multiple primary care clinics. Structured ideation methods and digital collaboration tools were used to generate, cluster, and refine ideas, which were iteratively synthesized.
Results:
Participants (N=69) from each group described a shared need for convenient, timely communication outside clinical encounters, but focused on different opportunities and challenges. Patients (n) emphasized access, usability, and frustration with opaque messaging processes. Clinic staff (n) highlighted message volume, triage complexity, and workflow burden, while family physicians (n) emphasized emotional labour, tension between patient-centred care and burnout, and the invisibility of messaging work. Through the co-creation process, participants identified three interrelated solution areas: (1) an information-flow management role or software to triage, categorize, and prioritize messages; (2) electronic communication standards that clarify appropriate use, response expectations, and responsibilities; and (3) user-centred messaging platforms . In the final multi-stakeholder workshop, participants underscored that sustainable funding, provincial policy direction, and coordinated governance are prerequisites for implementation.
Conclusions:
AM can support compassionate primary care when messaging is guided by shared standards, supported by active inbox management, and embedded in team-based, well-designed platforms. Clear roles, expectations, and enabling infrastructure may reduce clinician hesitation, expand capacity, and strengthen equitable, patient-centered care. Clinical Trial: Not applicable
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