JMIR Publications

ABSTRACT

Background:

Individuals with multiple chronic conditions (MCC) and mental health challenges like depression or anxiety have complex health needs and experience significant challenges with care coordination. Approaches to enhance care for patients with MCC typically focus on eliciting patients’ values to identify and align treatment priorities across patients and providers. Yet these efforts are often hindered by both systems- and patient-level barriers, which are exacerbated for patients with co-occurring mental health symptoms. Technology-enabled services (TES) offer a promising avenue to facilitate values elicitation and promote patient-centered care for these patients, yet TES have not yet been tailored to their unique needs.

Objective:

This study aimed to identify design and implementation considerations for TES that facilitate values elicitation among patients with MCC and depression or anxiety. We sought to understand the preferences of both clinicians and patients for TES that could bridge the gap between mental and physical health care.

Methods:

Using human-centered design methods, we conducted seven co-design workshops with 18 participants, including primary care clinicians, mental health clinicians, and patients with MCC and depression or anxiety. Participants were introduced to TES prototypes that utilized various formats (e.g., worksheets, AI chatbots) to elicit and communicate patients’ values. Prototypes were iteratively refined based on participant feedback. Data from these sessions were analyzed using reflexive thematic analysis to uncover themes related to service, technology, and implementation considerations.

Results:

Three primary themes were identified. Service Considerations: TES should help patients translate elicited values into actionable treatment plans and include low-burden, flexible activities to accommodate fluctuations in their mental health symptoms. Both patients and clinicians indicated that TES could be valuable for improving appointment preparation and patient-provider communication through interpersonal skill-building. Technology Considerations: Patients expressed openness to TES prototypes that used AI, particularly those that provided concise summaries of appointment priorities. Visual aids and simplified language were highlighted as essential features to support accessibility for neurodiverse patients. Implementation Considerations: Clinicians and patients favored situating values elicitation in mental health care settings over primary care, and preferred self-guided TES that patients could complete independently before appointments.

Conclusions:

Findings indicate that TES can address the unique needs of patients with MCC and mental health challenges by facilitating values-based care. Key design considerations include ensuring TES flexibility to account for fluctuating mental health symptoms, facilitating skill-building for effective communication, and creating user-friendly technology interfaces. Future research should explore how TES can be integrated into healthcare settings to enhance care coordination and support patient-centered treatment planning. By aligning TES design with patient and clinician preferences, there is potential to bridge gaps in care for this complex patient population.