Design thinking in cancer care: A systematic literature review

Abstract

Objective

Cancer can have a profound impact on the life of the patient, presenting challenges such as dealing with complex healthcare models and psychological burden. Implementing design thinking (DT) in cancer care can improve the quality of life for patients. Although DT has been used in healthcare, there is limited research highlighting use of DT in cancer care. The objective of this review is to explore the applications of DT within a cancer care context.

Methods

We systematically searched databases (PubMed Central, Scopus, and Medline) for relevant papers published between January 2018 and March 2023. Articles were identified using keywords: 'cancer', 'cancer care', 'oncology', 'design thinking', and 'design science'. Studies meeting our inclusion criteria were included and data was collected on the focus of study (i.e., design thinking and cancer care), target condition, target intervention and objective of the study. Thematic analysis was performed to identify recurring themes across studies. Articles were evaluated by the lead author and cross verified by the other two authors to reduce the risk of bias.

Results

Twenty studies were included out of the 160 articles identified whereby 11 focus on cancer care (5 patient-facing, 5 community-facing, and 1 provider-facing studies) and 9 on design thinking (5 patient-facing, 1 community-facing, and 3 provider-facing studies). Overall, seven themes were identified with several subthemes.

Conclusions

Our findings indicate that design thinking has been successfully applied to improve patient experiences in cancer care. By involving various stakeholders, including patients, healthcare providers, and communities, design thinking helps better understand real world problems. However, there is a gap in design thinking research concerning the long-term evaluation and scalability of design thinking-based interventions. Additionally, our findings suggest that mixed methods approach for future studies would support to establish more empirical evidence in this domain.

Keywords

Cancer care design thinking digital health empathy healthcare innovation patient-centric care

Introduction

Cancer care presents complex challenges that involve a broad range of stakeholders, with diverse needs of patients, families, and healthcare providers.¹ Acknowledging the significant impact of cancer on patients, it is crucial to adopt an empathetic and patient-centric approach with effective stakeholder engagement when addressing cancer related problems.¹ However, when designing new solutions, not all stakeholders are onboarded which often results in products with limited acceptability among patients. Design science and design thinking offer an empathetic and patient centric approach to tackle complex healthcare challenges.^2,3

Design Science is a methodological approach aimed at solving real-world problems by creating and refining models, methods, or tools. Originating in 1969 from Herbert Simon's foundational idea of the "science of design," is distinct from natural sciences in that it focuses on producing solutions rather than merely describing or predicting phenomena.⁴ Its primary goal is to address practical challenges by developing purposeful artifacts that improve outcomes in various contexts.

Both design thinking and design science stem from the broader discipline of design. While design thinking emphasises intuitive, creative, and human-centric approaches, and design science focuses on rigorous, systematic, and evidence-based methodologies, both share a commonalities as their commitment to problem solving, innovation and the development of actionable insights for real-world challenges.⁵ This combination of human-centred design thinking and research-driven design science enables healthcare systems to address complex challenges like cancer care, fostering the development of solutions that are both practical and deeply aligned with patient needs.

Design thinking is an iterative process with five key stages: empathy, problem definition, ideation, prototyping and testing. The empathy and define stages help us to understand the problem, with user involvement clarifying the exact nature of the problem. Ideation can be seen as a further exploration or continuation of the first two steps, focusing on how and what approaches to use in solving the defined problem. The final two stages, prototyping and testing, are where solutions become materialised. Testing and iteration of these steps, once again with user involvement, ensures stakeholder input throughout the process.

Design thinking not only prioritises empathy for user but also rapid prototyping and iteration in solution development. Design thinking traditionally refers to set of procedures used by designers in the process of designing⁶ associated with product development. Design thinking is now being used in multiple fields including healthcare settings although applications may vary.⁷ Applying design thinking principles within a healthcare context can be useful to ensure that problems are solved while considering patients’ needs and preferences, ultimately improving patient outcomes.⁸ Design thinking strategies have been used to examine how the built environment in cancer care facilities affects patient anxiety, and utilising patients personal experiences, led researchers to create individualised Patient Treatment Pods that enhance control, privacy, comfort, and reduce movement within oncology units.⁹ Using playful strategies and optimising care designers have been instrumental in creating strategies to improve the psychological well-being of patients, to alleviate anxiety, not only for the patients but also for their caretakers.¹⁰ Design thinking has been used to develop patient-centric medical information systems, prioritising ease of usability for patients.^11–16 Design thinking has helped develop new services such as development of web-based platform to communities at large, development of niche mobile applications for specific requirements of patients.^11,13,14

The objective of this review is to explore the applications of design thinking within a cancer care context. This systematic literature review examines studies that have discussed in detail or have employed design thinking strategies to better understand or solve cancer related problems, including educational and awareness initiatives, improvement of clinical workflows, development of digital applications for patients and the public. This review is critical as it focuses on empathy and patient involvement in cancer care. As healthcare continues to embrace modern technology, engaging patients and caretakers in developing digital solutions become essential. This also highlights the need for innovative approaches in addressing the complex challenges of cancer treatment and survivorship.^10,11,15 The review examines how design thinking principles have been applied across various cancer studies, identifies prevalent themes, evaluates the impact of these interventions, and identifies gaps in existing research. The main contribution of this research is a comprehensive insights into the role and potential of design thinking in cancer and cancer care related practices.

Methodology

Data sources

We systematically searched multiple databases for relevant papers published between January 2018 and March 2023. The databases searched were PubMed Central, Scopus, and Medline, which encompass a comprehensive coverage of peer-reviewed healthcare and medical studies, which directly align with the focus of our review on cancer care.^16,17 No additional databases were included as our priority was to target cancer care-related research, particularly in the context of design thinking applications. The authors conducted their search for papers in May 2023. To ensure comprehensive retrieval of relevant literature a combination of key terms as “'cancer', OR 'cancer care', OR 'oncology',” AND “ 'design thinking', OR 'design science'” was employed. The aim was to capture a wide array of studies, reflecting applications of design thinking across various contexts in cancer care.⁷ Whereas for future studies other keywords such as ‘user-centred design’, ‘human-centred design’ and ‘patient-centred design’ could help expand the scope of such a review.

Eligibility criteria

For the selection of studies, articles were reviewed using PRISMA guidelines as shown in Figure 1.¹⁸ Database search results were exported to reference and literature review manager software "Rayyan" to manage the research selection process. This tool was instrumental in eliminating duplicate entries and organising the screening process of abstracts.¹⁹ The evaluation was conducted by the lead author and was cross-verified by a second author to ensure consistency and reduce potential bias. Any disagreements were resolved through discussion and consensus in monthly meeting among all authors. All articles identified were subjected to a preliminary review based on title and abstract. Each article was categorised as “Include,” “Exclude,” or “Maybe” to facilitate a tiered approach to the selection process. Articles that were marked “Include” or “Maybe” were then subjected to a full-text review. Following explicit inclusion criteria were applied:

Articles must be written in English.

Articles must be published in peer-reviewed journals.

Articles must be published after January 2018

Eligible studies should incorporate design thinking in their research methodology, whether as the primary focus or in assistance to developing an intervention.

The content of the research must be directly related to cancer and/or cancer care.

Figure 1.

Prisma flow diagram, systematic review on design thinking in cancer care.

Given the diverse interpretations of design thinking in the literature, we established parameters to guide our selection. A study was considered aligned with design thinking if it included: (i) an assessment of user needs based on empathy, (ii) ideation processes that facilitate problem identification, and (iii) the creation or conceptualisation of a prototype, all indicative of the iterative design process central to design thinking.²⁰ This approach was adopted to distinguish design thinking methodologies from other similar approaches, such as agile frameworks and Plan-Do-Study-Act (PDSA) cycles. Consequently, our review focused exclusively on articles that explicitly described the use of a design thinking methodology according to the criteria specified above.

Data abstraction

Data were collected on the following indicators:

Publication Year: Research paper's publication year was recorded to assess the recency and relevance of the findings.

Study Focus: Studies were accessed according to its primary user that is patients, healthcare providers, or community. Studies were further classified as focusing on design thinking or cancer care. This classification helped in identifying the perspective and implications of the research.

Methodology & Target Condition: Methodology used in included research studies was observed such as workshop design or quantitative data collection, etc. Target condition refers to the specific aspects that studies aimed to address such as patient experience, time to treatment, or social determinants of cancer patient life etc. This was done to understand the scientific context of the study.

Geographical Context: The geographical location was noted to identify where the study was conducted to understand the regional implications and cultural context of the findings.

Further analysis of the research articles as summarised in Appendix 1 included observational data points for example, target condition/system process, intervention technique, study objectives, outcomes and results. Following the data collection, a detailed thematic analysis was performed to identify recurring themes, patterns, trends, and gaps in the literature. Thematic analysis is a qualitative method that involves key steps as familiarisation with the data through thorough reading and noting initial ideas, systematically coding significant features, sorting these codes into potential themes, and defining and naming each theme.²¹ This structured data abstraction process was essential for understanding the role of design thinking in enhancing various aspects of cancer care, as well as the identification of the areas where it may be most effectively applied. The review was not registered in any formal registry. The decision to forgo registration was made based on the exploratory nature of the review.

Results

Thematic analysis

Seven recurring themes were identified with multiple papers contributing to each theme, representing a multidisciplinary and collaborative nature of the design thinking approach. Table 1 presents a summary of the thematic analysis from our review.

Table 1.

Thematic analysis of included papers on design thinking in cancer and cancer care.

Theme	Sub-theme	Highlights
User-Centred Care	- Patient centred care - Provider centric care - Community centric care	Cancer and cancer treatment has a significant impact not only on patient's life but also on the people around the patient. User centred care provides an empathetic approach towards understanding the problem.^{9,10,12,13,15,28}
Digital Solutions	- Mobile app development - Web apps - Hospital information systems	As global healthcare undergoes transformation, there is a strong focus on developing digital tools for widespread use. These tools have the potential to benefit everyone involved in the cancer care process, including patients, doctors, and the broader community.^{11–13,25,26}
Cultural Context	- Patient inclusivity - Patient engagement	The importance of incorporating cultural knowledge, perspective and sensitivity into care practices, ensures inclusivity and relevance in diverse settings. Cultural context becomes important as most solutions in cancer and cancer care directly come in contact with the patient or user.^{14,15,29–31}
Operational Efficiency	- Reduction in time required to treatment. - Optimising workflow - Cost savings	As patient demand on healthcare facilities rises and the cost of accessing services increases, it is crucial to prioritise operational efficiencies to ensure that healthcare remains inclusive and accessible to all.^{11,24,28,32,33}
Educational Approaches	- Educating future healthcare workers - Community awareness - Patient awareness	As professionals create new services to address the needs of growing healthcare networks, it is equally important to ensure that users are properly trained and educated on how to use and benefit from these innovations.^{25,30,31,34,35}
Access to Care	- Physical access to Healthcare facilities - Access to relevant information - Cost of care	Access to healthcare facilities is limited by several factors, such as financial barriers, distance from modern hospitals, and lack of awareness. Healthcare professionals are working to develop solutions that address these and other challenges to ensure healthcare is accessible to all.^{10,11,14,26,35,36}
Long-Term Survivorship and Care	- Long term well-being of cancer survivors - Long term prognosis	Cancer treatment can be lengthy and time-consuming, often lasting for an extended period. Even after treatment, there is a substantial risk of the disease returning. This concern is especially pronounced among young cancer survivors.^{13,15,22,33,34}

The majority of studies that identified issues or devised specific solutions through design thinking typically engage users throughout the development phase. This is exemplified by studies such as development of information systems for cancer survivors²² and web-based interventions¹³ for patients. Patient centred approaches are proven to improve healthcare outcomes such as treatment adherence,²³ patient follow-up,¹⁵ patient experience,¹⁰ reduction in time to treatment.²⁴ Recently, there has been a growing need for digital solutions such as mobile health apps¹¹ and web platforms,¹³ which emphasise use of technology in improving patient experience.¹² Design thinking is also useful for integrating digital solutions with the existing hospital systems, keeping the needs of both healthcare providers and patients at centre of the developmental process.²⁵ In the case of cancer patients, digital solutions play a significant role such as online healthcare information systems that allow patient to access their medical records from comfort of their homes. Other key solutions are conducting self-testing screening programs,²⁶ delivering medicines directly to the patient's home,¹³ online appointment systems, and digital community tools that provide support and relevant information to the patients.²⁷

Design thinking principles such as empathy ensures solutions being developed are user centric and relevant in cultural context as well as ensuring patient inclusivity.³¹ This is important since solutions or interventions in cancer care directly interact with patient. Researchers have used culture as a tool to design strategies for cancer fundraising and determining treatment plans.^30,37 Differences in culture sometimes act as barrier to healthcare access, along with other factors.³⁸ Design thinking studies have been used to identify barriers and enablers to healthcare access.³⁵ It is essential to understand these barriers and enablers from the patient perspective, as this insight guides direction for future policymaking.¹⁴ Understanding these barriers and enablers is also crucial when managing cancer survivors or patients with long-term treatment plans. Survivors, particular those of young age have unique needs such as continuous medical surveillance.¹⁵ Surveillance and preventive strategies such as completing recommended surveillance tests of interest (echocardiogram, mammogram/breast MRI, or colonoscopy) ²²are essential in the broader context of cancer care, which focuses on holistic care beyond the initial treatment phase.^33,34

In healthcare operational efficiency is equally important and one such indicator that reflects on operational efficiency is time to treatment, researchers using design thinking and process mapping approaches successfully reduced the start time to treatment from appointment, with the median start time decreasing from 77 min to 47 min.²⁴ Research also puts emphasis on incorporating empathy and design thinking into education of upcoming generations of healthcare professionals, researchers argue design aspect is crucial specially in modern world, for example, to examine the potential of artificial intelligence in healthcare.^31,39 As the role of technology increases in healthcare it is important to embrace digital solutions such as web apps, m-health solutions in cancer care. Researcher has successfully used design thinking to better address the needs of patients and healthcare providers related to the digital solutions. Digital tools can be used to help patients with multiple aspects such self-management of breast cancer¹¹ or monitoring and interpretation of results and how to act upon them.¹³

Summary of findings

An overview of our findings includes title of the study, year of publication, journal of publication, location of study, primary focus (design thinking or cancer care), target user of the study (patient, healthcare provider, community). A detailed overview of study characteristics of all included studies is provided in Appendix 1.

The focus of the studies was assessed across two dimensions: (i) studies primarily focusing on design thinking or cancer care; and (ii) examining whether the studies were directed toward the community, patients, or healthcare providers.

Only three countries account for the majority of published studies, with Canada (n=4), Netherlands (n=3), and Singapore (n=3). In contrast, United States of America and Brazil had two papers and only one study originated from rest of the countries as shown in Appendix 1.

Patient facing studies (n=10): Patient facing studies developed interventions with patients as their primary users or involved patients in the solution development process. Examples of such studies include using playful strategies to foster well-being among paediatric cancer patients,¹⁰ development of web-based apps or mobile apps (digital tools) for cancer management by cancer patients,^11–13 or helping young cancer survivors with optimising their survivorship journey.^15,33 Of the ten patient-facing studies, five primarily focused on cancer care, while the other five centred on design thinking.

Community facing studies (n=6): These studies targeted communities and family members of cancer patients as their primary user. The aim was to use design thinking to address issues of public at large. Examples include research on lifestyle behaviour related to cancer prevention and control.³⁴ Other examples are the assessment and communication of the effects radon gas on cancer,¹⁴ as well as surveillance and support systems for childhood cancer survivors.²² Additionally, there are country wide self-screening programs for cervical cancer in Malaysia.²⁶ Studies also focus on addressing barriers and enablers for access to programs therapy in the Netherlands.³⁵ Finally, using patient-engagement to raise cancer awareness and cancer funding.³⁰ Out of six studies, primary focus of five studies was cancer care and one study focused on design thinking.

Provider facing studies (n=4): Provider facing studies targeted healthcare providers (doctors, nurses, pharmacists and hospital staff) as their primary user. Researchers argue about the importance of healthcare provider engagement and optimisation of providers time. Such studies include teaching cross cultural design thinking to healthcare students,³¹ reducing time to chemotherapy administration in outpatient setting,²⁴ reducing waiting time,³² nutritional assessment to identify and treat patients who are at risk of malnutrition.²⁸ The primary focus of one study was cancer care and three focused on design thinking.

Appendix 2 provides a summary on the methodologies, objectives, and results of the studies included in this review.

Discussion

We identified seven key themes across twenty peer-reviewed research articles, highlighting both the diverse applications of design thinking in cancer care and the limited research in this area. Design thinking in cancer care has been applied to a broad range of users, including but not limited to childhood cancer survivors,³³ healthcare provider,²⁸ educationalists.^31,39 Studies suggest that the adoption of problem solving approaches as design thinking in cancer care can help improve user experience for both providers ²⁴and patients.¹² For example, employing playful strategies or using purpose built architecture in oncology can help shift the focus from the disease to the well-being of the patient.^9,10 Additionally, the use of design thinking principles such as empathy and prototyping in development of purpose built digital health tools indicates a broader industry shift toward.^11–13 Researchers have used design thinking to help future clinicians, engineers, and scientists prepare to contribute to the AI revolution in healthcare.³¹ For example, generative artificial intelligence (GenAI) has been used to assist in design thinking process⁴⁰ and GenAI has promising potential in patient education and communication within the field of cancer care.⁴¹

Design thinking has been applied to a diverse set of applications, such as focusing on architectural adjustments in treatment facilities to reduce patient anxiety,⁹ prioritising operational efficiencies such as reducing waiting time chemotherapy administration by redesigning preparatory processes,^24,32 developing patient centred communication platforms and tools,²⁵ personalised reminders tools for cancer survivors,³³ and digital platforms to raise awareness among cancer patients and communities.^11,13 Design thinking can be implemented as a complete framework, with all steps followed but also at each step using basic design tools such as journey mapping, brain storming, co-creation etc.^10,35,42

As the name suggests, a journey map is a tool used to visualise the experiences or journeys of stakeholders, such as families and clinicians, during critical moments like acute illness. It provides a step-by-step view of when and how a patient interacts with a service. This is beneficial in understanding the emotional and practical journey of individuals, offering insights into their needs and pain points during different phases of the healthcare process.²²

Brainstorming is a key tool mostly used in the ideation phase, helping teams explore diverse set of options. Brainstorming sessions may include patients, community, healthcare staff and other stakeholders in one session and start with divergent thinking (a phase where even wild ideas are welcomed) and end with convergent thinking (phase where only most liked and practical ideas are shortlisted).¹³

Co-creation is a collaborative process in which stakeholders work together to develop solutions. During this process, all participants actively share their insights, experiences, and ideas to influence the design of a product, service, or system. Co-creation typically takes place during the prototyping phase.¹²

While these standalone interventions may not be seen as critical to medical treatment, when used together, they can play a valuable role in addressing the often-overlooked psychological aspects of cancer care. Additionally, as our findings suggest, incorporating cultural sensitivity and contextual relevance into the cancer care journey can significantly enhance the patient experience. Design thinking can effectively bridge cultural gaps, improving the patient journey by ensuring that interventions are not only medically effective but also culturally meaningful.^31,38 The findings emphasise that design thinking is not a one-size-fits-all solution but rather a flexible set of principles that can be tailored to different aspects of healthcare. This adaptability is essential for tackling the unique challenges posed by cancer and cancer care, which demand human compassion.^2,10,22

Strengths and limitations of studies

In the context of the selected studies on design thinking in cancer care, the following strengths and limitations are notable. Design thinking caters to unique needs of patients, ensuring development of patient centric solutions. Patient-centric solutions have been proven to improve healthcare outcomes, patient experience and overall satisfaction.²³ Several studies demonstrate high rates of adaptability towards the use of innovative ideas in addressing healthcare challenges. Design thinking studies also considers diversity and inclusivity to ensure solutions developed are appropriate not only medically but also ethically. This aspect is vital as designers are developing solutions for the global population but needs for individuals may vary and must be catered accordingly.⁴³ Another strong aspect of design thinking is that it encourages interdisciplinary collaborations, integrating insights from various stakeholders ranging from professionals to patients and family of patients.⁴⁴

The user centric nature of design thinking creates a limitation when it comes to scalability and solutions are limited to specific demographics. Scalability of design thinking based studies can be resource intensive.^45,46 Another limitation is that research studies face challenges such as small numbers of participant or short monitoring durations, affecting the relevance of outcomes. Additionally, the preference for qualitative methods, including workshops and interviews, introduces complexity due to their depth but potential for researcher bias, which could sway result interpretation. Impact of such methodological constraints has been mentioned in literature.^47,48 In contrast, quantitative data, characterised by statistical measures may provide a different dimension of understanding, allowing for the generalisation of results and statistical validation of hypotheses.^49,50

Another limitation is that this review focused only on peer-reviewed journal articles to ensure the rigor and quality of evidence, this means the exclusion of conference proceedings and other sources. This may have resulted in the omission of important contributions to design thinking that are not available in peer-reviewed journals. Future reviews could consider expanding the scope to include relevant conference proceedings and other non-traditional publications to provide a more comprehensive understanding of the application of design thinking in cancer care.

These strengths and limitations highlight the complexity of design thinking in cancer and cancer care, emphasising the necessity for mixed qualitative and quantitative methods in design thinking research. This approach will illuminate the advantages and disadvantages of applying design thinking principles in cancer care, supported by robust scientific evidence.

Research gaps with design thinking in cancer studies

Design thinking requires multiple iterations of prototype development and feedback collection, which can be both time and resource consuming and most research studies are limited by the amount of time that is allotted to certain study. There is a need for longitudinal studies in this domain to assess improvements made during multiple iterations and long-term impact of strategies and products designed.^14,51 Another significant research gap is that most studies are qualitative in nature and have a smaller sample size of participants.^9,35

While some research has already demonstrated the scalability of design thinking solutions, further studies are needed to assess their scalability and practicality in various healthcare settings. Such research will enhance the legitimacy of design thinking and similar problem-solving approaches in healthcare.^13,26,27 Additionally, research often focuses on integrating advanced digital tools into existing systems. Before implementing advanced technologies such as artificial intelligence, machine learning, augmented reality, or mixed reality, it is essential to thoroughly test them to ensure they are beneficial and have minimal or no side effects.^11–13 As healthcare adopts digitalisation, it is crucial to safeguard patient data privacy and alleviate concerns regarding medical information. Further efforts are necessary to enhance digital health literacy among both patients and healthcare professionals.^11,52

Conclusion

This systematic literature review critically examined the role and impact of design thinking in cancer care. The findings reveal that design thinking has potential to significantly improve patient experiences, with an emphasis on patient-centred and culturally sensitive care approaches. By involving various stakeholders including patients, healthcare providers, and communities in process, design thinking ensures that the solutions developed are aligned with the real needs of end users. The research suggests that design thinking can be successfully applied at various stages of cancer care, such as improving patient communication strategies, enhancing survivorship care, and implementing digital health interventions.

This review makes a theoretical contribution by enhancing the literature on the significance of empathy and stakeholder involvement in healthcare innovation. It acknowledges the limitations of applying the design thinking process, as its outcomes and suggestions may not be generalisable due to variations in user preferences across different contexts. Practically, the application of design thinking can positively influence cancer care by fostering the development of digital tools that are accessible, user-friendly, and effective. The creation of patient-centric digital tools and secure access to patient data through an intuitive interface have emerged as crucial areas, highlighting the need for empathetic technological integration in healthcare.

Future research should concentrate on assessing the long-term impact of design thinking applications in cancer care. Additionally, there is a need to investigate the scalability of design thinking solutions in various healthcare settings, especially in low- and middle-income countries. The adaptation of modern technologies, such as artificial intelligence, machine learning, and digital transformation, can also be further explored through frameworks like design thinking. We summarise a future research agenda as follows:

Long-term impact assessment of design thinking in cancer care: Investigate the sustained effects of design thinking applications on patient outcomes, healthcare processes, and overall quality of care in cancer treatment over time.

Scalability of design thinking solutions in diverse healthcare settings: Explore the adaptability and scalability of design thinking frameworks in various healthcare environments, with a particular focus on low- and middle-income countries, to understand the barriers and facilitators to implementation.

Integration of modern technologies in design thinking frameworks: Examine how advanced technologies, such as artificial intelligence and machine learning, can be effectively incorporated into design thinking processes to enhance innovation and improve cancer care delivery.

Patient-centric digital tool development: Research the design and implementation of patient-centred digital tools using design thinking principles, assessing their usability, accessibility, and effectiveness in improving patient engagement and health outcomes.

Cultural sensitivity in design thinking applications: Investigate how cultural factors influence the design and implementation of healthcare solutions derived from design thinking, particularly in cancer care, to ensure that interventions are empathetic and contextually relevant.

In conclusion, design thinking presents a promising strategy for addressing many challenges in cancer care. By refining and expanding the use of the design thinking framework and its applications, healthcare professionals can aid in developing more patient-centred solutions that enhance the quality and accessibility of care.

Footnotes

Consent statement

This study did not involve any primary data collection from patients, and therefore patient consent was not required.

Contributorship

All authors contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript. All authors reviewed and approved the final manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Ethical approval was not required for this study as it is a systematic review of existing literature and did not involve any human or animal subjects.

Funding

This research is led by Lero - the Science Foundation Ireland Research Centre for Software and supported with the financial support of the Science Foundation Ireland grant 13/RC/2094_2 and the University of Galway.

Guarantor

Muhammad Mohsin Memon guarantees the integrity and accuracy of this work.

ORCID iD

Muhammad Mohsin Memon

Appendix 1: Study characteristics and design thinking methodology

Title	Year	Journal	Location	Focus (DT or CANCER)	Primary stakeholders (Patient or provider or community facing)
Playful strategies to foster the well-being of pediatric cancer patients in the Brazilian Unified Health System: a design thinking approach	2021	BMC health services research	Brazil	Design thinking	Patient facing
Teaching cross-cultural design thinking for healthcare	2020	The Breast	Portugal	Cancer care	Provider facing
Cancer Treatment Facilities: Using Design Thinking to Examine Anxiety and the Patient Experience	2018	Journal of interior design	USA	Cancer care	Patient facing
From evidence to implementation of lifestyle behaviour in cancer prevention and control: A Preventive Medicine Golden Jubilee Commentary	2023	Preventive Medicine	Canada	Design thinking	Community facing
Reducing Time to Chemotherapy Administration in the Outpatient Setting of a Tertiary Cancer Centre Using a Design Thinking Approach	2020	Blood	Singapore	Design thinking	Provider facing
The development of a mobile health app for breast cancer self-management support in Taiwan: Design thinking approach	2020	JMIR mHealth and uHealth	Taiwan	Cancer care	Patient facing
Co-Designing Communication: A Design Thinking Approach Applied to Radon Health Communication	2023	Int J Environ Res Public Health	Belgium	Cancer care	Community facing
The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach	2020	J Med Internet Res	Netherlands	Design thinking	Patient facing
Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study	2022	JMIR human factors	Canada	Cancer care	Community facing
Breaking the patientification process—through co-creation of care, using old arctic survival knowledge	2021	International Journal of Qualitative Studies on Health and Well-being	Sweden	Cancer care	Patient facing
Optimizing Survivorship Care Services for Asian Adolescent and Young Adult Cancer Survivors: A Qualitative Study	2020	Journal of Adolescent and Young Adult Oncology	Singapore	Cancer care	Patient facing
The Implementation of a Primary HPV Self-Testing Cervical Screening Program in Malaysia through Program ROSE-Lessons Learnt and Moving Forward	2022	Curr Oncol	Malaysia	Cancer care	Community facing
Clues to address barriers for access to proton therapy in the Netherlands	2023	Radiother Oncol	Netherlands	Cancer care	Community facing
Rationale and development of an e-health application to deliver patient-centered care during treatment for recently diagnosed multiple myeloma patients: pilot study of the MM E-coach	2023	Pilot Feasibility Stud	Netherlands	Design thinking	Patient facing
Redesign of radiotherapy for prostate cancer: a proposal for universal healthcare systems	2023	Journal of Comparative Effectiveness Research	Brazil	Design thinking	Patient facing
Co-creation of a patient engagement strategy in cancer research funding	2023	Research Involvement and Engagement	Canada	Cancer care	Community facing
Reducing Chemotherapy Waiting Times in the Ambulatory Setting of a Tertiary Cancer Centre Using a Design Thinking Approach	2023	Cancers	Singapore	Design thinking	Provider facing
Expert design thinking workshops to analyze users’ perceived applicability of NUTRI-ONCOCARE algorithm to prevent and treat malnutrition in cancer patients under routine clinical practice conditions in Spain: the ALLIANCE study	2023	Supportive Care in Cancer	Spain	Design thinking	Provider facing
Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach	2024	Patient Education and Counseling	USA	Design thinking	Patient facing
Protocol for the ONLOOP trial: pragmatic randomized trial evaluating a province-wide system of personalized reminders for evidence-based surveillance tests in adult survivors of childhood cancer in Ontario	2024	Implementation Science	Canada	Cancer care	Patient facing

Appendix 2: Study objective and results

Title	Target condition/System Process	Technique/Intervention Method	Objective of the study	Results	Outcomes
Playful strategies to foster the well-being of paediatric cancer patients in the Brazilian Unified Health System: a design thinking approach	Subjective well-being of paediatric cancer patients	Playful strategies (developed via workshops)	to identify how playfulness, whenever applicable, can be used as a strategy to improve the subjective well-being of paediatric cancer patients.	Developed strategies using lucid interfaces (such as toys) to support psychological wellbeing of children and improve health education and communication focusing children	Mixed success with working model being implemented but with room for improvement.
Teaching cross-cultural design thinking for healthcare	Cross-cultural design-thinking and challenges for Artificial Intelligence in breast cancer care.	“Maymester” course on Biomedical Engineering Design	To prepare the next generation for cross-cultural design thinking, crucial for AI to achieve its full potential in breast cancer care.	Substantial growth of students in global learning and intercultural knowledge and competence.	Success
Cancer Treatment Facilities: Using Design Thinking to Examine Anxiety and the Patient Experience	Patient experience (Affected by the built environment in cancer care facilities)	Design Thinking Workshops	To examine if the built environment in cancer care facilities influences anxiety in patients and to generate patient-driven solutions.	As a result of workshops, Participants generated a number of interesting ideas early on selected optimisation of time and minimal movement as the focus for subsequent workshops.	Mixed success with low attendance and diverse set of ideas generated
From evidence to implementation of lifestyle behaviour in cancer prevention and control: A Preventive Medicine Golden Jubilee Commentary	lifestyle behaviour (Physical activity)	Framework to use systems, causal and Design thinking	To identify knowledge gaps in between different biomedical sciences and science of behaviour change in relation to physical activity and cancer control.	Developed a translational research framework to guide lifestyle interventions by combining systems, causal and design thinking.	Not Applicable
Reducing Time to Chemotherapy Administration in the Outpatient Setting of a Tertiary Cancer Centre Using a Design Thinking Approach	Time to treatment for oncology patients	Dashboards development (appointment, queue management and chemotherapy systems)	To reduce time to treatment, improve operational efficiency and staff and patient experience.	The median time to start treatment decreased from 83 min in the control to 49 min in the study group. The proportion of patients starting treatment within 1 h of their appointment time increased to 59.6% from 37.8%.	Success
The development of a mobile health app for breast cancer self-management support in Taiwan: Design thinking approach	Breast cancer self-management	Mobile app	This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app.	Overall 8 main themes were identified and on that basis team developed framework for a breast cancer self-management support mHealth app.	Mixed success (as sample size is inadequate and the use of app needs professional supervision)
Co-Designing Communication: A Design Thinking Approach Applied to Radon Health Communication	Communication, barriers & facilitators regarding the Radon protective behaviour (one of leading causes of lung cancer)	Explore radon protective behaviour& Co-designing communication tools (via Design thinking workshops)	to co-design communication tools to raise awareness regarding potential effects of radon on health.	Researchers suggested that communication strategies should be made user friendly. Barriers & facilitators to engaging in Radon protective behaviour need to be promoted.	Success
The Development of a Web-Based, Patient-Centred Intervention for Patients With Chronic Myeloid Leukaemia (CMyLife): Design Thinking Development Approach	Chronic Myeloid Leukaemia	web-based platform with multiple features	To develop a patient-centred solution for patients with Chronic Myeloid Leukaemia.	Researchers developed and pilot tested a web-based platform (namely CMyLife) with multiple features. Features included a website with reliable information, a forum, personal medical records with logs of symptoms and laboratory results, a guideline app, tailored feedback based on the patients’ symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home.	Success
Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centred Design Study	childhood cancer survivors	A website - To find relevant information. Information & reminder letters to cancer survivors and Physicians. Also Survivor information kit.	To design a provincial support system for high-priority tests for Childhood cancer survivors, informed by principles of implementation science, behavioural science, and design thinking.	Researcher developed a multifaceted intervention using design thinking and behavioural theory to elucidate the barriers and enablers to complete recommended surveillance by survivors of childhood cancer.	Success (but needs evaluation through randomised controlled trial)
Breaking the patientification process - through co-creation of care, using old arctic survival knowledge	Cancer patient participation and psychosocial health	Revision of old studies based on Momentary contentment theory and interviews.	To explore how Momentary contentment theory may be used to improve patient participation and psychosocial health.	introduced an alternative to patientification including the use of Momentary contentment theory and patients can be taught to be submissive towards the healthcare provider	Success (with potential for future research)
Optimizing Survivorship Care Services for Asian Adolescent and Young Adult Cancer Survivors: A Qualitative Study	Cancer survivorship services	Focus group discussions with adolescent and young adult (AYA) cancer survivors and healthcare professional.	To explore the perceptions about survivorship services from adolescent and young adult (AYA) cancer survivors and healthcare professional in Singapore to propose service design and delivery strategies.	Research work suggested proposals to engage cancer survivors in useful survivorship services through the conceptualisation process, implementation features, outreach potential, and evaluation measures. Also that different stakeholders such as government, healthcare services need to work together to create a better experience for survivors	Success
The Implementation of a Primary HPV Self-Testing Cervical Screening Program in Malaysia through Program ROSE-Lessons Learnt and Moving Forward	Self-sampling of cervical screening	Program ROSE, a 5 step procedure to enhance testing experience.	To understand the barriers to Implementing the WHO Cervical Cancer Elimination Targets.	highlighted how Pilot Project ROSE incorporated evidence- based tools that rapidly scaled up to Program ROSE	Success
Clues to address barriers for access to proton therapy in the Netherlands	barriers for access to Proton Therapy from National Indication Protocols, Netherlands	Nationwide survey and in-depth interviews with radiation oncologists (ROs) and patients. This was followed by workshops with ROs from one proton therapy centre and from referring hospitals.	To identify the barriers for access to PT and to design interventions to address these barriers.	Barriers for access to PT were identified and designed interventions to address these barriers. Study suggested to prioritise in the interorganisational care pathway of proton therapy patients in The Netherlands.	Mixed Success with effectiveness of interventions developed yet to be tested.
Rationale and development of an e-health application to deliver patient-centered care during treatment for recently diagnosed multiple myeloma patients: pilot study of the MM E-coach	Patient experience for Patients with multiple myeloma (MM)	E-Coach (Application)	To develop a patient-centred multi-modality e-health application, to assess the application for usability and end-user experiences.	Team developed a multi-modality application consisting a newly developed medication module, patient-reported outcome (PRO) questionnaire assessments, a messaging service, alerts, information provision, and a personal care plan. The median system usability score was 60 on a scale of 0–100.	Mixed Success
Redesign of radiotherapy for prostate cancer: a proposal for universal healthcare systems	Prostate cancer	Strategies affecting hospital processes and impacting patients’ care pathways	To recommend strategies to improve prostate patients’ access to radiotherapy treatment in the Brazilian Unified Health System, along with a cost-tool to support radiotherapy care pathways’ lead times and costs.	A time-driven activity-based costing monitoring using data extracted from ARIA was coded and can be used by centres as a cost assessment guide.	Success
Co-creation of a patient engagement strategy in cancer research funding	Patient engagement in cancer research funding	Design thinking based workshops	To co-create a patient engagement in cancer research strategy with patients, survivors, caretakers and researchers. The goal of this strategy was to meaningfully and systematically engage with patients in research funding and research activities.	The Strategy Development Team successfully co created a multi-faceted patient engagement strategy for patient engagement in cancer research funding, specific to Canadian cancer Society.	Success (with recommendations from study being implemented and evaluated)
Reducing Chemotherapy Waiting Times in the Ambulatory Setting of a Tertiary Cancer Centre Using a Design Thinking Approach	Time to treatment, preparatory processes.	Prospective single-arm study with a historical control group	To investigate and improve the efficiency of chemotherapy delivery by reducing wait times in a tertiary cancer centre.	Study shows that a multidisciplinary group using a data-driven, design thinking approach to address team silos, reorganise and track work processes can effectively bring about change in outpatient chemotherapy delivery processes.	Success
Expert design thinking workshops to analyze users’ perceived applicability of NUTRI-ONCOCARE algorithm to prevent and treat malnutrition in cancer patients under routine clinical practice conditions in Spain: the ALLIANCE study	User's opinion/perspective	Design thinking Double Diamond process based workshops	To analyse users’ opinion about NUTRI-ONCOCARE algorithm (nutritional screening tool for patients with Solid Tumours)	Researchers found that this tool (NUTRI-ONCOCARE) could be valuable for integrating nutrition into routine cancer care, acknowledging the need for nutritional assessments from diagnosis through disease progression. The implementation of the tool faces challenges such as time constraints, staff shortages, and lack of managerial support	Success
Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centred communication in ovarian cancer care: A design thinking approach	Patient-centred communication	Collaborative Agenda-Setting Intervention (CASI)	To use design thinking for developing an intervention to promote Patient-centred communication in ovarian cancer care.	The intervention, integrated within the existing electronic health record, supports clinicians and patients. Stakeholders, including patients and healthcare providers, responded positively to the prototype.	Success
Protocol for the ONLOOP trial: pragmatic randomized trial evaluating a province-wide system of personalized reminders for evidence-based surveillance tests in adult survivors of childhood cancer in Ontario	Childhood cancer survivors	ONLOOP- health information delivery system	To provide adult survivors of childhood cancer with detailed health information, including summaries of their childhood cancer treatment and recommended surveillance tests for early detection of cardiomyopathy, breast cancer, and/or colorectal cancer, with personalised reminders over time.	it is a protocol at this stage, but study will determine that whether intervention "ONLOOP" is effective at helping childhood cancer survivors complete their recommended surveillance tests or not.	Not Applicable

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