Sexuality and intimacy remain important aspects of quality of life in the context of incurable cancer and palliative care, yet they are often difficult to address within healthcare practice and intimate relationships. People with incurable cancer and their partners experience changes in intimacy, communication, and relational balance, while support for these experiences is often limited or primarily medically oriented. This graduation project explores how design can sensitively support sexual well-being in palliative care.

The project was conducted as part of a broader research initiative at Erasmus Medical Center and focused on translating qualitative research insights into a concrete design concept. A combination of design research methods and qualitative healthcare research approaches, including literature review and in-depth interviews, was used to explore the problem space.

The research identified two central relational mechanisms: autonomy and communication. Partners often struggle to express personal needs without guilt, while communication about intimacy becomes challenging due to emotional burden and shifting relational roles. These insights informed the formulation of design opportunities and guided a broad exploration of possible design directions.

Through a structured selection process, one concept direction was chosen for further development: the Pillow Partner. This concept consists of a pair of connected pillows that allow partners to record and listen to intimate voice messages. It aims to support autonomy by enabling control over timing and emotional exposure, and to support communication by offering an indirect and less confrontational medium for sharing sensitive thoughts.

The concept was refined through expert interviews and exploratory user interviews, which provided insights into emotional impact, usability, and contextual sensitivity. Key findings emphasized the importance of a warm, non-medical and gender-neutral design, physical comfort, and a sense of connection, while also revealing tensions between autonomy, simplicity, and relational responsibility.

Finally, implementation considerations were explored, focusing on low-threshold introduction, discretion, privacy, and the supportive role of healthcare professionals. Rather than presenting a final solution, this project offers a grounded design concept and strategic directions for further development. It demonstrates how design can meaningfully contribute to supporting communication and autonomy in intimate relationships affected by incurable illness, while acknowledging the ethical and emotional complexity of this domain. ... Read more

This thesis focuses on the development of an end effector for a robotic system that aims to improve CT-guided core needle biopsies. This is a procedure, performed by interventional radiologists, used to diagnose lung cancer. The procedure involves using a co-axial needle to extract tissue samples from a suspected tumor inside the lungs for laboratory analysis.

This project was initiated by Syntric Medical, who had several questions that needed answering for the end effector of their robotic system. The aim of the project was to advance the prototype by reducing ambiguity on the three priority areas: Usability & workflow, Safety & Sterility and Technology & Integration.
... Read more

From the 2020s onwards, our society has dealt with many high-impact crises, such as the COVID-19 pandemic, the Suez Canal obstruction, and the Russo-Ukrainian war. These crises exposed multiple fragilities in our transportation system, supply chains and national security. In reaction to these crises, the interest in operationalising resilience by translating resilience aspiration to actionable interventions (e.g. training, products and strategies) peaked within multiple organisations. In this context, the Delft University of Technology in collaboration with the Royal Schiphol Group, the operator of Amsterdam Airport Schiphol, initiated a PhD research project to investigate how to operationalise resilience. Key to this project was its action research approach, through which I, as the PhD researcher, closely collaborated with the Innovation Hub and Operational Resilience team of the Royal Schiphol Group. This fruitful exchange between academia and practice resulted in five studies, each presented as a separate chapter, contributing a key piece to the puzzle of operationalising resilience... ... Read more

A positive digital patient experience can improve health and care outcomes, but a positive digital patient experience does not just happen; it refers to understanding, evaluating, and improving the entire patient journey through digital health. Human-centered design is often applied to understand patients’ needs and improve patient experiences when designing digital health solutions. However, human-centered design for digital health is demanding. It often involves multiple stakeholders with different values and requires evidence for implementation. Patient perspectives routinely differ from those of other stakeholders. Even within the same patient group, individual situations are also often different from each other. Yet, it is not always apparent that patients were engaged in the design process and were empowered enough to voice their opinions. Listen to the patients’ voices and uncover their unique needs; designers are expected to speak for patients. This thesis aims to support designers in improving the quality of care in digital health by defining, evaluating, and designing digital patient experiences. This thesis is divided into three parts to achieve this goal.

Part A: defining digital patient experiences
To build a common understanding of digital patient experiences among design, technology, and healthcare communities and to facilitate transdisciplinary knowledge exchange and learning between these different fields for driving digital health innovation, this part contains one chapter and focuses on defining digital patient experiences. In chapter 2, we proposed the term “digital patient experience” as a common phrase to describe the patient experience in digital health and defined “digital patient experience” by synthesizing the reported patient experience or user experience of varied digital health interventions from multiple reviews. Specifically, the concept of the digital patient experience was defined as “the sum of all interactions affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channelling digital health.” In addition, we identified information on influencing factors and summarized them into 9 categories (i.e., patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment). These categories were classified into positive, negative, and double-edged factors based on their positive, negative, or dynamic impacts on digital patient experiences. Furthermore, we uncovered 4 design constructs (i.e., personalized, information, navigation, and visual design) and 3 common design methods (i.e., user-centered design or human-centered design, co-design, and inclusive design) as design considerations for addressing digital patient experiences. Finally, we proposed a framework and 9 design guidelines to help digital health designers and developers improve digital patient experiences throughout the entire design process.

Part B: evaluating digital patient experiences
In the second part, we discussed the importance of evaluating digital patient experiences, developed an evaluation guide to help digital health researchers, designers, and developers further evaluate digital patient experiences, and conducted a case study to evaluate digital patient experiences in a clinical setting. Following the research findings of Chapter 2 on defining the digital patient experience, in Chapter 3, we first identified five typical evaluation objectives and related stakeholder groups. We then described potential evaluation timing considerations in terms of 4 intervention maturity stages and 3 evaluation timings. We also collected knowledge on evaluation indicators of digital patient experiences and grouped them into 3 categories: intervention outputs, patient outcomes, and health care system impact. These were then classified into 9 themes (i.e., intervention functionality, usability, care quality, patient emotional outcomes, perceptual outcomes, capability outcomes, behavioral outcomes, clinical outcomes, and system economic outcomes) and 22 subthemes. Furthermore, we noted a set of common study designs, data collection methods, and instruments, as well as data analysis methods, that can be used or adapted to evaluate digital patient experiences. To facilitate the standard evaluation of digital patient experiences, we recommend 6 directions for further research on digital patient experience evaluation. In Chapter 4, we conducted a prospective observational study to evaluate digital patient experiences of using virtual reality distraction in wound care for pain management. This chapter can be used as an example for guiding digital health designers and developers to evaluate digital patient experiences in clinical settings. It also offers inspiration to improve the design, development, and implementation of the virtual reality distraction in wound care for better digital patient experiences. For example, We found that patients who had high levels of technology acceptance, pain during previous wound care, or previously used VR distraction in wound care were more willing to use VR distraction in wound care. These findings indicate patient behavioral determinants have an influence on their intention to use digital health solutions, which supports our findings in Chapter 2 that patients’ behavioral determinants influence patient perceptions of using digital health. In addition, in Chapter 4, no evidence was found on the effectiveness of virtual reality distraction in significantly reducing pain or anxiety during wound care. Although many studies have indicated the effectiveness of using virtual reality distraction in wound care for pain management, our research results do not support this argument. To avoid ineffective digital health implementation, we encourage more rigorous research on investigating the effectiveness of virtual reality distraction in wound care or how to improve its effectiveness through design. Besides, on average, the digital patient experience and patient satisfaction with using virtual reality distraction in wound care were positive, which reveals that although digital health solutions do not always lead to a significant better health outcome, they can contribute to a better treatment experience, which is also very valuable.

Part C: designing digital patient experiences
In the final part, we focus on guiding the design of digital patient experiences. We investigated the general human-centered design process in digital health and synthesized all research findings to generate a web-based design guide to support the understanding, evaluation, and improvement of digital patient experiences. In chapter 5, we mapped the (re)design and continuous improvement processes in digital health into 8 stages and grouped them into 4 phases: preparation, problem-thinking, problem-solving, and implementation. We also identified 12 challenges and classified them into 4 categories: contextual, practical, managerial, and commercial challenges. Furthermore, we outlined 8 corresponding strategies, recommended by the participating designers, to address each challenge type. Finally, we created a framework including design deliverables, activities, involved stakeholders, design challenges, and related design strategies for each design stage. The framework not only aids designers in understanding the design practices in the healthcare industry but also guides them when managing their digital health design processes towards the improvements of digital patient experiences. In chapter 6, we presented a web-based digital patient experience design guide that synthesized the previous research findings, and we further evaluated the design guide. We show that our digital patient experience design guide was evaluated as usable with good content quality, but that it needs further improvement in providing relevant, detailed, and resourceful content, intuitive and interactive interfaces, as well as simple and ready-to-use templates. We believe these improvement insights are relevant for developing and evaluating design guides in general. In addition, participants reported conflicting tensions in the guide’s design, requiring a balance between specific and general, less and more, as well as fixed and flexible. These tensions reveal the diversity and conflicts in students’ needs for useful and effective design guides. On the one hand, users want design guides to hold relevant, detailed information and content, provide a systematic overview, include complete conceptual explanations, detailed design cases, and integrated design resources, enabling them to use the design guide as a resource library for flexible exploration. On the other hand, they want a design guide to be simple and easy to use, offering concise and clear information with low learning and usage costs, enabling them to effortlessly complete efficient designs. We believe this study serves as an example, inspiring future design researchers to develop and evaluate their own design guides.

In conclusion, this thesis contributes theoretically (via new knowledge) and practically (via the design guide) to facilitate a scientific impact on the definition, evaluation, and design of digital patient experiences from a human-centered design perspective, thus, supporting the improvement of the quality of care in digital health solutions. ... Read more

This thesis explores design interventions for individuals with Developmental Topographical Disorientation (DTD) and others with weak navigational skills. “DTD refers to the lifelong inability to orient in extremely familiar surroundings despite the absence of any acquired brain damage or neurological disorder” (Iaria & Burles, 2016) This research focused on addressing the gap between allocentric navigation (map-based, provided by technology) and egocentric navigation (personal perspective), which many individuals with DTD struggle to translate effectively in their daily life. 

The research goal was to explore how to better support people with DTD, as well as others with below average navigational skills, in bridging the gap between these two navigational perspectives. Interviews with students and recent graduates who self-identified as having poor navigational skills revealed low spatial anxiety, likely due to their reliance on GPS. Based on these interviews and navigation technology research, wayfinding guidelines were developed, emphasizing clear visual landmarks that simplify the cognitive translation between map-based and personal navigation.

A design concept was created which presents the directions to take in a landmark based map, with a song as a mnemonic aid to learn the navigation instruction. Focusing on how individuals use both allocentric and egocentric perspectives to navigate an evaluation with participants who self identify as not having good navigation skills, navigated a virtual environment using the concept. Results showed that while a multisensory approach can be useful, clear and simple visual cues, such as the selection of one specific landmark per decision point, are more effective in aiding navigation.

In conclusion, the study shows design guidelines to simplify the transition between allocentric and egocentric navigation, and to motivate the user to memorize the route rather than relying solely on technology or multisensory tools. It also highlights the need for greater awareness of DTD and offers insights into designing accessible, user-centered navigation tools. ... Read more

Every year in the Netherlands, approximately 100,000 patients are diagnosed with cancer (https://www.nki.nl/.) . With these numbers on the rise, and a shortage of staffing, there is an increased workload on the existing professionals to work fast, despite the complexity and meticulous nature of radiotherapy planning. There are multiple obstacles that may cause a buildup and inability for a smooth flow of a patient through the system, sometimes causing oncologists to lose track of the patients' situation in the care pathway. This further builds onto the pyschological stress owing to their sense of responsibility towards the patient in the process, and to their need to preserve their control over the patient's treatment process.

With increasing demand to work with complex systems and technology, there is also an increasing reliance on the smooth operations and uniform working methods of other professionals and colleagues for the radio oncologist's smooth workflow. But there are currently some unaddressed operational and working issues faced by the Erasmus radiotherapy department that attribute to inefficiencies, delays, and loss of patient status in the pre-treatment process. Hence there is a strong motivation to explore this space through the project, where there is currently a lack of solutions towards optimising and supporting the professionals in this stage of the process.

The design hence focuses on supporting oncologists in the treatment planning phase by providing real-time patient status, assistance, and prioritization of tasks and administrative work in order to minimize disruptions and gain control over their workflow, such that oncologists can uphold their sense of accountability towards their patients, themselves, and the organizational expectations and alleviate their fear of losing the patient to the system.

The end result is an omnichannel solution that works on two levels- through an iPad-based solution for the radiation oncologists to help manage their workflow, as well as a data collection strategy for the managers to capture valuable data throughout the pre-treatment process to identify delays and inefficiencies.

The project employs both UX as well as system-level approaches in order to cater to professional, process-related, and organizational needs to ultimately reduce patient waiting time and alleviate workload.
... Read more

The increasing waiting times in youth mental health care pose a significant challenge, driven by a shortage of specialists and external factors that complicate diagnosis and prolong treatment. Shoshin, a multidisciplinary strategic design and innovation agency, has developed a solution known as the Fit Op Weg Poli (FOWP) to address this issue for adult care at GGZ Delfland. This thesis aims to engage youth healthcare providers in the development of a youth FOWP.

To tackle the design challenge, the double diamond method is applied, involving extensive research and collaborative sessions. This process led to the development of LooS, a co-production framework tailored for young individuals aged between twelve and twenty-seven years old. Co-production for LooS leads to improved service delivery and increased efficiency, aiming to transform youth mental health care.

LooS incorporates several crucial elements to support youth mental health. An easily accessible well-being gym is provided, empowering young individuals to enhance their resilience and overall well-being. A walk-in centre offers a safe and non-judgmental space for peer interaction and support. The intake process involves a comprehensive assessment, and each young person is assigned a dedicated buddy who provides support throughout their recovery journey. Welcome packages are provided to manage expectations and offer essential resources, including e-health tools and information about the recovery process.

Recovery is facilitated through group sessions with a recovery coach, accompanied by the use of e-health tools for progress monitoring and exercises for continued growth. LooS aims to transition 20-30% of clients to a stage where therapy is no longer required, while those who still need therapy will receive specialised group therapy, after recovery.

In the case of a crisis, the program can be scaled up swiftly to provide immediate support. After a crisis, diagnosis-specific therapy will always be provided, and the recovery coach ensures continued aftercare. The aftercare is structured in layers, offering self-testing and a safety net for a smooth transition. Once individuals no longer require aftercare, they bid farewell to their buddy and continue working on their mental resilience in the well-being gym.
LooS is designed to be adaptable for implementation in multiple centres/locations across The Netherlands, allowing for widespread access to youth mental health care.

To support open discussions with healthcare providers, a visual aid called the “Praatplaat” and a brochure have been created. These tools highlight the impact of LooS on the care pathway and waiting times to enable engagement among healthcare providers to co-produce their own LooS centres. A comprehensive blueprint has been developed, providing a clear and structured guide for the co-development process of Shosin with healthcare providers.

In conclusion, LooS is a new approach to youth mental health care, focusing on proactive work on mental resilience, accessible support services, and collaborative engagement. By implementing LooS, the aim is to transform the youth mental health care system, reduce waiting times, and provide holistic care for youth. LooS offers a path towards improved outcomes and well-being, ultimately creating a brighter future for the youth of The Netherlands.
... Read more

This report delves into the challenging process of translating complex tests from the Child Brain Lab into a design that is both accessible and engaging for children. The Child Brain Lab, part of the Erasmus MC Sophia Children’s Hospital, conducts research on brain development to gain a better understanding of the course of brain disorders and improve treatments for children with brain disorders. In return for children’s participation in the lab, the hospital aims to provide them with a child-friendly patient dossier: The Self-portrait. The goal of this project is:

To design a digital solution that translates the results from a selection of tests that are performed in the Child Brain Lab, into a meaningful contribution for children (developmental age 6-12 years old) with brain disorders, that will increase their participation in their care path, and positively support their developing self-image.

To design a solution that caters to the needs of the child patients, first the problem space was explored, through literature research and interviews with stakeholders. Within the age range of the target audience, children develop their language skills and transition from imaginative thinking to more logical reasoning. These cognitive abilities influence the formation of their self-image, which led to the framework for contributing to self-image: ‘Look what I did’ - ‘Look how I did it’ - ‘Look how I did it and what I learned from it.’ This framework was used to adapt the app to the needs of the target audience. In addition, the participants’ brain disorders present additional challenges, such as poor eyesight and a need for predictability.

The tests for which a translation is being made in the app are the EEG, IQ test, and walking mat. Each of these tests comes with its own set of challenges. For example, the data from the EEG test is complex and elusive for children, and the analysis is quite intricate for physicians. The results of the IQ test are highly valued.
The discovery phase revealed five trade-offs, such as the balance between providing honest information or protecting a child by sharing only positive information. The insights led to the design goal:

Create a personally rewarding visualization of the test-data of the EEG, IQ-test and walking mat for each child that visits the CBL, by highlighting their personal achievements and empowering children to become aware of and accept who they are, in a form that is integrated in the clinical workflow of the Pediatric Brain Centre, and supportive during the full care journey, so that HCPs see the Self-portrait as an enrichment to their work.

The result is an interactive prototype of The Self-portrait, inviting children to explore the world of their own brains. Each test is developed with its own character. For instance in the case of the walking mat, animals are used to give children insights into their walking patterns, envisioning enriched dialogues between children and physiotherapists, potentially leading to improvements.

Throughout the app’s development, all stakeholders have been involved multiple times, ensuring the right balance is struck in the design between presenting accurate information aligned with clinical practice while also appealing to children.

Through this endeavor, the project aims to bridge the gap between complex medical data and child-friendly interpretations, fostering a better understanding and engagement with one’s health metrics.
... Read more

This thesis is initiated by the Reinier Haga Orthopaedic Centre (RHOC) and shows the creation of a patient-centred healthcare network for orthopaedic hand and wrist care. A healthcare network can be defined as a group of interconnected stakeholders that directly or indirectly influence the patient’s care. In this project, the involved stakeholders are people undergoing treatment for their hand and wrist and healthcare providers from seven disciplines; orthopaedic surgeons, hand therapists, general practitioners, plaster technicians, orthopaedic instrument makers, rheumatologists and rehabilitation physicians. A literature review and a user research study sketch the context and underlying problem. The context is shaped by ongoing developments that cause an increase in the care demand, an increase in healthcare costs, empowered patients and digitalisation. This asks for care that is efficient and gives patients more control. Currently, both are lacking in orthopaedic hand and wrist care. The user research, which consists of interviews with the stakeholders, shows that patients are not feeling involved, and inefficient guidelines and lack of cooperation prevent an efficient treatment process. The hand and wrist is a speciality within the medical field of orthopaedics. It entails a wide range of care disciplines that could benefit a well-connected network, which is currently missing. This prevents effective cooperation, which research showed would lead to more efficient and improved care, fewer treatment sessions and a reduction in costs (Ypinga, 2018). The developed design aims to create more involvement of the stakeholders in the orthopaedic hand and wrist care and active participation of the patient. This design is developed through ideation using the “How-Tos” method, which resulted in three ideas that three healthcare providers reviewed. This approach gave insight into the aspects that were perceived as most relevant by them. These were: an overview of the whole treatment, which helps in contacting other healthcare providers, holistic treatment and patient involvement. In addition, allowing patients to set a goal for their treatment allows for more control and better treatment. With this input, the concept of WegWijs is developed and evaluated with patients. WegWijs means to be wise, informed and in control in healthcare. It provides all the stakeholders with the knowledge needed to create a holistic and patient-centred care process by providing an overview of the treatment process and the involved parties. The patient actively shapes their treatment by formulating a treatment goal and cocreating their treatment plan with the doctor. The care providers remain actively involved throughout the process and in close contact with each other, creating a well-connected healthcare network. Two patients and two healthcare providers validated these aspects. The established implementation strategy outlines the required steps that include the co-creation of new protocols and the execution of a pilot. However, further research is needed to develop this concept and implement it in the RHOC, and eventually in the wider healthcare system. ... Read more

Background:
The HIV outpatient clinic of Amsterdam University Medical Centers (AUMC)is implementing digital patient-reported outcomes measures (PROMS) in routine care to improve the quality of life (QoL) for people living with HIV (PWH). We were asked to design tools to promote the participation of patient groups from Ghana and Nigeria.

Methods:
Two sets of methodologies were used: qualitative research methods informed the development of a ‘patient journey’ and design-thinking methodologies informed the tool development. Participant observation and in-depth semi-structured interviews were conducted to gain insights into patient- and system-related characteristics. Design-thinking methodologies facilitated the transformation of qualitative data into insights that drove design concepts. Three ideation methodologies were used to create four concepts, leading to the final concept.

Results:
Observations of 17 individual consultations (6 female, 11 male) at the HIV outpatient clinic resulted in six recurring themes. These themes were: Personal relationship; Disclosure; Impact of the diagnosis; Health literacy & Health involvement; Communication; No-shows. The observations and additional literature research informed the development of an interview guide. Seven interviews (5 female, 2 male) were conducted with participants from Ghana and Nigeria. The observations and interviews informed the patient journey (PJ). The PJ showed that patients experience stress and anxiety prior to and during their hospital visit but fully trust doctors and nurses. Based on the insights the design challenge was addressed, leading to the following concepts: “Peer support community”; “Wellbeing Diary”; “Waiting Room Inspiration”; “Hospital Roadmap”.

Conclusions:
Amsterdam UMC will adopt the “Wellbeing Diary” which embodies the following characteristics: independence from relying on other organisations or infrastructure for implementation; a visual design that can be used independent of literacy level; and its affordability. The paper diary will provide a low-threshold tool for people to record PROMs-like experiences that will prepare them for their consultations at the outpatient clinic.
... Read more

For hemophilia patients, a simple fall or injury can cause excessive bleeding, which if not handled properly can cause major disabilities and in extreme situations even death. Due to the insufficient blood coagulation factors in their system, a fun day can easily end in the emergency room. Children, by nature, are still learning how to move and navigate the world. Where an adult may know the consequences of their actions, a child may not be able to see that, and therefore are an especially vulnerable group. With many challenges in their daily life, children with hemophilia have a complex experience with the disease. In collaboration with Partitura and the Sophia Childrens Hospital, the goal of the project is to analyze the experience of severe hemophilia patients aged 0 to 8, visualize this in the form of a patient journey built from their perspective and find opportunities and patterns in the experience to eventually create a proposal for an intervention to improve quality of life.

A patient journey was created, in order to visualize this complex experience. The journey showed that there were definitely opportunities for improvement, giving an overview of the different touchpoints the patient goes through in the 3 main phases, (1) diagnosis, (2) treatment and (3) living with hemophilia.

The patient journey, as well as various methods of research including a literature review, observations in the outpatient clinic and interviews with healthcare professionals, parents and patients showed that children want to feel more in control of their disease, and have more structure/predicability in their experience with hemophilia. Especially the 3 main contact areas of the patient, (1) home, (2) the outpatient clinic and (3) the emergency room, provided room for these needs to be met.

Based on the research outcomes, a design goal was formulated for the creation of an intervention: To design an intervention for children with severe hemophilia aged within the range of 0-8 years, that helps empower them and help them better comprehend their journey with the disease, by providing structure, consistency and control. 3 concepts were created, all serving the different contact areas of the patient, with the overarching purpose of helping the child be more involved and active in his healthcare. The concepts were designed as seperate interventions, which can be combined and used together to strengthen each other by improving the patient experience in the different areas of the child’s life. The evaluation sessions, carried out with parents and healthcare professionals showed that the concepts had a lot of potential, and was met with great enthousiasm. This project concludes with recommendations for the next steps, for the implementation of the interventions and also further research opportunities in the experience of children with hemophilia. The next steps for the project will be to prepare for implementation, with interest to implement nationally, and eventually to aid in improving the patient experience of children with severe hemophilia, not only in the context of the Sophia Children’s Hospital but all patients of the Netherlands. ... Read more

IntroductionThis Strategic Product Design master thesis aims to find a solution to the problem of ill fitting care trajectories that result in overtreatment, higher costs and negatively impacted health outcomes. This project was created with the recently founded Reinier Haga Orthopedic CenterLiterature and Field studiesTo understand the problem and identify solutions, research studies were conducted.A literature study identified potentials solutions, tt also provided insights into the condition of knee arthrosis and how healthcare is currently organised.Two field studies were also done. The first were interning sessions that provided additional knowledge on the organisation of the healthcare.The second were interviews with patients and treatment providers which, resulted in an understanding of what patients and medical professionals miss in the organisation of the care trajectory.Design goalFrom the literature and field studies came that a cause for the problem is the interaction between stakeholders. Information exchange between the medical professionals was chosen as the design problem. As a lack of information about a patient as a whole explains the ill fitting care trajectories. The missing information was identified as implicit contextual patient information. This often left out of the referral and can not be used when making the treatment decision. Based on the above, a design goal was formulated:Enabling easier sharing of contextual patient information between the GP and the OS in the initial referralCreative processA co-evolutionary creative process was used to create a solution. This was heavily influenced by the COVID-19 outbreak, resulting in more validations with the client rather than large stakeholder sessions.CICSThe result is the Contextual Information Communication System (CICS). CICS consists of the Contextual Sharing Tool (CST) and the requirements for its functioning.The CST is a visual tool that enables fast capture and review of contextual patient information by the GP. The GP uses it by setting 5 points for the respective information rubrics along an axis that indicates the significance of that rubric for a patient.This CST gets shared with the orthopedic surgeon, together with the textual referral. It does not provide him with the detailed information, but with an overview of significant information rubrics. The surgeon uses this impression to direct their anamnesis during patient consults. If the consult has not resulted in an explanation of the CST, there is an opportunity to clarify it with the patient’s GP in a conversation. EvaluationEvaluation was done, to validate the design. From this evaluation came that the CICS did indeed meet the design goal.Points of improvement were also identified among which the usability of the current visual design and the need for education on how CICS should be used.Recommendations & Implementation roadmapTo provide the orthopedic center the next steps in CICS development, a recommended implementation roadmap was created. This roadmap shows the steps necessary to reach three defined horizons:The start of a CICS pilotFull CICS implementation in the knee arthrosis trajectoryExpansion of CICS to other care trajectories. ... Read more

Boys with Duchenne Muscular Dystrophy have a different life from most children. As they grow up, their muscles lose strength progressively. Around the age of 10, they lose their ability to walk, in their teens they slowly lose their arm function, in their twenties they often need respiratory support and their life expectancy is usually between 30 and 40 years old.

To support Duchenne boys’ physical functioning and contribute to their independence, a passive exoskeleton has been developed to support their arm function. The exoskeleton is designed to be physically most beneficial for boys with Duchenne between 10 and 17 years old, which is therefore defined as the target group. It is expected that, as the boys in this target group mature, both their physical and emotional needs regarding medical aids, such as exoskeletons, will change. However, the exoskeleton is not yet able to mature with the user, to accommodate for those changing needs. The design goal of this project is therefore to redesign the exoskeleton to increase its ability to mature, both physically and emotionally, with Duchenne boys from 10 to 17 years old. In order to understand the requirements needed to meet the design goal, both physical and emotional needs of Duchenne boys are researched through a literature study and user research.

Literature shows that the boys can physically benefit from the exoskeleton from the moment of wheelchair confinement (around the age of 10), but do not usually use arm supports until a much later age, or not at all, indicating a lack of perceived relevance for the target group. It also shows that there is a high variety in disease progression, so it cannot be predicted when the exoskeleton needs to be altered to fit and support the user physically.

User research shows that there are three phases of growing up with Duchenne (Naïve Playful Kid (10-12 years old), Anxious Self-Conscious Teen (12-15 years old) and Constrained Reluctant Adolescent (15-17 years old)), who differ on topics such as confidence level, attitude towards their disease, responsibility, social life, relation with their parents, and relation towards healthcare products. Products can have a positive influence on emotional development if they can improve independence and individual functioning. Products can have a negative influence if they feel like an imposition, if the user has no control or choice over them, and if the introduction or alteration of the products confirm further muscle decline.

For the exoskeleton to fit with the physical and emotional maturing process, it should therefore achieve the following design goals. The use of the exoskeleton should be made more relevant for each of the three emotional phases of growing up; the user should be able to focus on positive progress and anticipate on negative decline; the exoskeleton should accommodate for an increasing responsibility and independency of the user; and the user should feel like he has a sufficient amount of control and choice over the exoskeleton.

For the exoskeleton to achieve these goals, a new concept is proposed, which consists of three components. Firstly, the exoskeleton is given an added functionality of controlling devices in the user’s house, by making movements. Secondly, an interface containing a coding platform enables the user to decide which devices are controlled with which movements, and through a communication platform he can ask questions and share experience. Thirdly, a service in which an expert regularly checks the exoskeleton’s hardware (physical fit and support) and software (controlling functionality).

The concept increases the ability of the exoskeleton to mature with its user, because it ensures the exoskeleton fits well with the needs of all different ages in the target group and because the target group expects the concept to remain interesting for a longer period of time. They expect this because of the amount of possibilities and adaptabilities the interface provides, but also because of the combination of fun and extra independence the extra controlling function provides directly when using the concept. Furthermore, the expert service ensures the physical fit and support of the exoskeleton is regularly checked and updated, without confronting the target group negatively regarding their physical decline. By implementing the concept, the exoskeleton is expected to continue to be relevant for boys with Duchenne and give them a more positive experience as they mature from children to adults. ... Read more

This project aims to develop tailored non-invasive ventilation (NIV) masks for children in the Paediatric Intensive Care Unit (PICU), to offer suitable masks and to improve the NIV intervention. In the PICU, there is a preference for NIV compared to invasive ventilation, because of complications, such as airway injuries. Their biggest challenge is finding a suitable non-vented NIV mask. They often do not fit well, resulting in too much air leakage and patient-ventilator asynchrony. This increases the breathing effort of the patient, and can lead to NIV failure. The air leakage is often too high, therefore the mask has to be repositioned and tightened to reduce the air leakage. This disturbs the patient and influences the patient’s comfort.

The core problem of NIV is the excess of unintentional air leakage. Therefore the main focus lies on reducing air leakage by increasing the fit of the new developed NIV mask. The new masks need to fit patients up till the age of seven, because the available masks do often not fit well. There are no non-vented NIV masks available for patients below one year. An oronasal mask is developed, it is most effective and relatively non-intrusive compared to the other types of non-vented NIV mask. NIV at the PICU can be divided into acute NIV, for which an acute NIV mask will be developed, and extended NIV, for which an ideal NIV mask will be developed.

Four concept NIV masks are developed, of which two concepts are selected based on the results of the simulation and most important requirements. The NIV intervention is simulated by ventilating a reanimation mannequin with prototypes of the concepts to determine the effectiveness in terms of air leakage and contact pressure. The two selected concepts shows reduced air leakage compared to commercially available masks.

The final design proposal consists of two masks: the Modular Mask, and the Quick Curable Mask. The Quick Curable Mask is developed for patients who require acute NIV. The Modular Mask is developed for patients who need NIV for an extended time. Due to overcrowding at the PICU of Amsterdam UMC there was a shortage of NIV tubes and sensors, it was not responsible to test the masks. Therefore a protocol is written to test the air leakage and evaluate the wearing comfort of the two proposed masks with a test participant after the COVID-19 pandemic.

The final design proposal is suitable for NIV at the PICU. A roadmap describes how the two mask can be further developed by the hospital and implemented in the PICU. It consists of the following phases: the optimising phase, the clinical testing phase, the implementing phase, and the redesigning phase.
... Read more

This graduation project is performed for the Dutch Medicines Evaluation Board (MEB) in collaboration with VU University Medical Center (VUmc), Department of Obstetrics and Gynaecology. In many situations pregnant women need to use a medicine during pregnancy, especially when they are under medical supervision at VUmc due to their (history of a) complex pregnancy. For instance to treat an underlying chronic disease or pregnancy related conditions. In every decision about medication use, the necessity needs to be weighed against the potential risks of the medicine, as well as the risks when not taking the medicine for both mother and child. Literature research has shown that pregnant women often overestimate the risks associated with medicines and therefore do not take their medicines as prescribed. Current information sources, such as patient leaflets and online websites, usually stress the risks and show reluctance towards the use of medicines during pregnancy, while they lack the benefits of medicines. User research has shown that pregnant women are very afraid of the potential risks and only want to take a medicine when there is a clear benefit for their child. Usually they have a lot of trust in their gynaecologist and follow their advice to use a particular medicine. However, women easily start to doubt whether their medicine is really safe due to negative information from others or in the media, or because they do not clearly remember the benefits of the medicine. As a result, they seek confirmation and reassurance by searching information via Google or in the patient leaflet, where they often only find unnerving information that increases their concerns. Based on these research insights, the goal was to design a product-service system, including a digital application that informs pregnant women about the use of medicines during pregnancy and allows them to make an informed decision and feel confident to use a medicine during pregnancy. The final design, ‘Mijn Medicijn – Zwangerschap’ is an application that pregnant women can consult at any time when they are in doubt of the safety of their medicine. It provides balanced and transparent information about both the potential risks and the benefits of medicines for the mother and unborn child. This allows pregnant women to understand why a medicine may be important for their situation, which is expected to make them feel more confident to use the medicine during pregnancy. Additionally, the app shows what medicines can or should not be used during pregnancy for a certain complaint or condition. The gynaecologist plays an important role in the design as well, by providing an information flyer and stimulating the patient to use the app. Furthermore, when advising a medicine, the gynaecologist explains the relevance of the medicine by using the same benefit-risk information in a desktop version of the app. An evaluation study with an interactive prototype showed that pregnant women highly value the product service system in general as well as the patient-friendly information, which would support them in making decisions about medication use. ... Read more

In 2018, both of Amsterdam’s academic hospitals(VUmc & AMC) officially merged into the Amsterdam UMC. As part of thismerger two neonatal Intensive care units (NICU) are merging as well. Thisproject aims to increase the job satisfaction of NICU nurses in thispost-merger department. TheNICU nurse
A neonatal intensive care unit nurse treats premature borninfants as young as 24 weeks after the pregnancy. Besides nursing they guideparents through this emotional and unstable first phase of parenthood. Largerproblem
There is a global nurse shortage and this is also noticed atboth NICU departments. Attending this issue is even more urgent now sincemergers are often associated with higher job dissatisfaction and higher staffturnover rates (Martin, 2008). 
Designproblem
Job satisfaction is globally considered to have a pivotalrole in nurse turnover and the quality of care for patients. (Lu, 2019). At this moment there is no active pursuit toincrease nurse job satisfaction at the Amsterdam UMC. This leads to thefollowing design problem:
Howcan design thinking (empathize,define, ideate, prototype and test) be used todefine and shape future employee experiences in order to improve jobsatisfaction in a post-merger NICU department? 
Design research (empathize)
A NICU nurse profileof ten work values isestablished. These values are then compared to the organizations core values.Furthermore the different work cultures of both NICU groups are explored. 
Design goal (define)
The value ‘rewards me’is fulfilled the least well while being perceived as relatively important bythe nurses. Therefore the designgoal is:
Improving the NICU nursing staff’s feeling of being rewarded for workrelated efforts in order to increase their overall job satisfaction.
A future experience map (ideate)
To define and shape future NICU nurse experiences, a future employee experience map is made. Promising solutions are also placed in theemployee experience map.
Boost (prototype)
One concept in the future experience mapis prototyped and tested. This concept is the ‘Boost’ concept which aims atimproving employees wellbeing by facilitating a short personal moment away fromall stimuli during a workday. At the VUmc the concept is prototyped. Walls andceilings are covered with blankets and a massage chair, exercise area andreading corner are created.
Promising results (test)
For three weeks the Boost concept is piloted in the VUmc. Compared to the zeromeasurement a small but positive increase is observed. This data combined withthe desirability of the conceptshows that the boost concept has the potential for increasing jobsatisfaction. 
Recommendation
Although more measurements are needed the Boost concept shows the potential toincrease job satisfaction. Many more ideas are mapped in the future experiencemap. This leads to the following final recommendation:
Combine the future employee experience map with a design thinking mindset (empathize,define, ideate, prototype, test) to realize many incremental gains in nurse jobsatisfaction in order to fight the nurse shortage issue.
... Read more

Healthcare-Associated Infections (HAI) can occur when microorganisms spread between hospitalized patients. To prevent highly contagious or resistant microorganisms from spreading from one patient to the other, isolation precautions such as contact isolation are applied when patients carry such a microorganism. The first part of this theses describes how contact isolation has a negative impact on well-being on patients. The experience during contact isolation can improve by establishing an open healthcare environment and providing information during the full isolation process. Collective action theories appear to have potential to be applied to the context of infection prevention. The contribution of patients, healthcare providers and visitors to infection prevention can be stimulated by increasing community feeling, establishing connections between individuals and providing information about past actions of other individuals. Context research has been conducted in VUmc and results on the current patient experience are gathered in a patient journey. Conclusions on the current patient experience during isolation are as following: 1. a shattered sense of responsibility amongst different actors 2. different patient persona’s experience contact isolation differently 3. a difference in experience and behaviour of first time isolation patients and readmitted patients. To improve the patient experience during contact isolation, the second part of this thesis focusses on creating a solution. By combining the conclusions and the literature, a design vision is formulated: I want to increase the feeling of community amongst all actors in the contact isolation process, so that all individuals experience a sense of shared responsibility towards infection prevention in VUmc. A first step towards the design vision is created with the guidance of the following design goal: I want patients to develop a favourable attitude towards contact isolation during the first time into contact isolation by providing a tool that lets them experience partnership with healthcare providers and visitors in contributing to the safety of others. Building from the patient journey and the design goal, a solution, Bundel, is proposed. It aims to increase a feeling of shared responsibility amongst the different involved actors and stimulated collaboration between individual. Bundel provides necessary and desired information to patients and visitors at fitting times. The first time into contact isolation is slowed down by spreading the information a patient needs and wants over the isolation process. By providing all the information to patients from the start of the isolation process, they can discover the necessary information they are looking for when they are ready. In addition, visitors are increasingly involved in infection prevention, because the design makes their involvement necessary them. Bundel thereby stimulates them to personally find the necessary information. For nurses and other healthcare providers, Bundel facilitates the transfer from a ‘controller and corrector’ to a ‘guide and facilitator’ towards patients and visitors. Therefore, responsibility that currently mainly lies with the nurse, shifts to a more equally shared responsibility amongst all actors. ... Read more

What role patients should assume in medical decision making is an issue that has stimulated much debate. A wide variety of opinions exist, ranging from the view that patients should assume at least some responsibility for their own treatment, to the position that it is unwise to encourage such participation because patients do not have the specialised knowledge required to make treatment decisions (Degner, Sloan, 1992). The difficult process of shared decision making (SDM), is a process in which the physician shares with the patient all relevant risk and benefit information on all treatment alternatives and the patient shares with the physician all relevant personal information that might make one treatment or side effect more or less tolerable than others (King, Eckman, & Moulton, 2011). SDM is currently being advocated by both healthcare professionals and patients as the ideal for decision making (Stiggelbout, Pieterse, & De Haes, 2015). The process of SDM is difficult to implement, for example because it has proven difficult to create access to balanced and easy to understand information for patients. The difficulty of implementing SDM also applies to adjuvant chemotherapy treatment decisions regarding patients with colon cancer. This decision-making moment occurs after surgery when the pTNM-classification (UICC, 2010) shows a certain value which suggests if adjuvant chemotherapy is applicable. During the multidisciplinary consultation (IKNL, n.d.) the best treatment option is discussed in the eyes of the physicians. This is then shared with the patient during the consultation with the oncological surgeon. During the next consultation with the oncologist, it is expected of the patient to make a final treatment decision. Different research methodologies like literature research, semi-structured interviews and observations were performed to obtain the understanding of the current decision-making procedure concerning adjuvant chemotherapy for colon cancer patients. The insights obtained from the observations and semi-structured interviews, were used to create the patient physician experience journey. Combining this with the theoretical framework, the design goal for this project emerged.   The aim of the design process was to Create a User Interface for a web application that ensures that both patient and physician are aware of the different possible treatment options, understand what these treatment options involve concerning risks, treatment options and possible outcome, according to the principles of risk communication, and that interaction can take place, so that the preferences and values of both patient and physician can be shared, to support the process of SDM concerning adjuvant chemotherapy for colon cancer patients. From the patient physician experience journey, combined with the theoretical framework, the IPD was created through multiple iteration steps, involving physicians, patients, and potential patients. The IPD allows the patient to find general information about adjuvant chemotherapy, and triggers the patient to think about their preferences and values concerning quality of life, which can be scored and communicated with the treating physicians. Added to that, the patient and physician are both enabled to gain insights from prediction information about life expectancy. The IPD allows both patient and physician to be aware of the same amount of information and to understand what this information entails, which, according to the literature, is the condition to be able to implement the SDM process properly. Because this project was carried out in the name of IKNL, the IPD was created for a small fraction of the numerical information database they possess, with the purpose to be able to project the principle of the IPD on their entire database to help as many cancer patients as possible with their valuable information. When patients are more involved in making treatment decisions based on the process of SDM, it may have influenced the patient experience in a positive was, leading to a better quality of life of the patient. When the quality of life of the patient is improved due to the provided care, it can be said that the quality of care has also improved. ... Read more

This graduation project has been carried out in the context of the research project ‘Tailored Healthcare through Customer Profiling’ at the TU Delft, in collaboration with hospital Reinier de Graaf Group in Delft, and medical device company Zimmer Biomet. Together we focus in this project on the rehabilitation journey after total hip replacement (Total Hip Arthroplasty, THA).

The central aim of this project has been to find out how different patient profiles benefit from different interaction features in the rehabilitation device ‘BioCoach’, to effectively support them in their rehabilitation process.
This project investigates how a tailored version of the BioCoach could meet the needs and wishes of three different patient profiles: the ‘optimistic’ patient; the ‘managing’ patient; and the ‘modest’ patient. ... Read more

The National Immunisation Programme (NIP) provides Dutch children with vaccinations for twelve infectious diseases free of charge and on voluntary basis. During several years, the vaccination coverage in the Netherlands has declined (about 0.5 percent per year). It is important to have a high vaccination coverage in order to stop spreading diseases and reaching herd immunity. This herd immunity, of which the minimum percentage differs per disease but lies around 90 percent, protects the people that cannot be vaccinated due to illness or are too young to be vaccinated.

This graduation project focuses on risk communication, presenting both advantages and disadvantages, about the first child vaccinations (DKTP-Hib-Hepb and pneumococcal vaccination between 6 and 9 weeks of age). The project does not focus on increasing the vaccination coverage. The goal is to support (soon to be) parents in a decision making process based on information in order to strengthen those who are positive towards vaccination and help the people who are doubting about participation in the NIP. People who do not have the intention to participate in the NIP are not taken into account. In order to find the most applicable strategy or means of communication, the target group was involved during the whole project.

Different theories about behavioural intentions and decision making processes were examined which has finally led to the model that can be found in Figure 1. This model is based on the normative description of an analytical process of making a choice from Timmermans (2013) represented by the pink boxes. In collaboration with experts, this model is adapted as is visualised by the dotted parts. The short-cuts that are added visualise more intuitive decision making strategies (heart and eye) and a thorough analytical approach that iterates between structuring and evaluation (scale).

Information needs and sources that are used by the target group are found by doing seven interviews with people in the target group. Several ideas with applicable approaches towards communicating the information were formed out of these insights. The ideas led to three design concepts that communicate the information in different ways; positive towards vaccination (focussing on the benefit of herd immunity), as transparent as possible (by showing both advantages and disadvantages) and negative towards vaccination (focussing on the side effects that can occur).

The front pages of the concepts (see Figure 2) are designed for intuitive people. Those who have a more analytical approach will go through the different steps as stated in Figure 1 by opening the leaflet. Recommendations for improvement of these concepts and future research could be made after five concept tests with the target group. The concepts were evaluated and ranked in the test.

The seven interviews that were held and the five concept tests resulted into interpretations of only those people involved. Because only a small amount of participants is used, the data is mainly used for inspiration and not for conclusions about the overall target group.

This project is done in collaboration with the RIVM and VUmc. ... Read more