In 2006, Pfizer acquired Tanezumab, a monoclonal antibody which, when delivered subcutaneously, works against nerve growth factor that causes chronic pain. Since then, Pfizer has partnered with Eli Lilly to launch randomized controlled trials and launch Tanezumab as a treatment for late-stage rapidly progressive osteoarthritis (RPOA) and chronic lower back pain (CLBP). We worked with the patient experience team at Pfizer & Lilly to develop their patient support program that will help patients adhere to treatment, feel supported by their providers and Pfizer/Lilly, and achieve optimal outcomes while on treatment.
Project objectives | Introduce a human-centered approach to developing a patient support program for Tanezumab, a non-opioid pain treatment for patients with RPOA and CLBP.
Experience ambition | To create tools that help patients feel supported and adhere to treatment in order to support optimal outcomes on Tanezumab.
Project components | Qualitative research; Solution co-creation with patients and providers; service blueprinting; CX playbook
Role | Design lead
Duration | 12 weeks (multi-year program)
Pain is a personal experience
Chronic pain is difficult to diagnose | Each person experiences pain differently. When pain interferes with the ability to engage in everyday tasks and enjoy everyday life, it can become isolating, and lead to a downward spiral both of physical ability and emotional isolation.
Pain and function are connected | Pain is a barrier to improving function. But, in order to improve function, patients often need to “work through the pain” (in addition to receiving pain relief support) to increase strength. In addition, the classic pain scale is not an accurate tool to measure change over time. While there are validated scales that include both pain and function measures, the relationship between the two is often difficult for patients to understand.
Pain and self-Identity | Pain patients often feel defeated by their pain, and feel that they will never get to do the activities that they value. Their current level of pain often becomes their new normal, and they identify with their “number” on the pain scale. The focus on pain as a component of self-identity encourages feelings that individuals are a burden to those that care for them, leading to further isolation and reducing the likelihood that they will engage both physically and emotionally in the moments that matter to them.
In addition to compliance with FDA safety requirements, the Tanezumab patient support program will help patients set realistic goals about their pain reduction and improving function, recognize the relationship between pain and function (and encourage PT), and give providers the tools they need to support treatment and ongoing support to improve function and quality of life.
Co-creating a support program with patients and providers
Identifying and prioritizing opportunities | In 2018/2019, it was still unclear what the extent of the safety requirements for the FDA would be. To ensure that we would have all the necessary components for the program if the drug were to launch, we followed the most conservative scenario. This scenario included the addition of additional steps in the qualification process for both patients and providers, and giving patients a NSAID intake tracker.
Multi-step qualification | The qualification and safety measures required to onboard a new patient on to Tanezumab was both variable by country and also not yet determined by the FDA. Throughout this process, however, there were many points at which both patients and providers needed context as to why these steps were necessary, and guidance as to how to get the right appointments at the right time. This is a particularly complex component when scaling the program across geographies with different medical systems.
NSAID restrictions | A major design challenge was helping both patients and providers understand restrictions of other medication while on Tanezumab. While on treatment, patients are strictly limited in their use of NSAIDs (e.g. Ibuprofen). Not only are NSAIDs a common class of drugs for daily management of pain, but many patients don’t know which drugs are NSAIDs, and may accidentally take these medications. While the recommendation is to avoid NSAIDs, we needed to ensure that both patients and providers understood the restriction, and had the tools to track their NSAID use.
Supporting the patient-provider relationship | Patients with chronic pain can experience mistrust of medical providers who they perceive as “not believing” in their pain or its severity, or unwilling to help alleviate symptoms. Providers often have limited tools at their disposal to treat patients, and are hesitant to prescribe medications (especially opioids). They struggle to encourage patients to go to physical therapy, or overcome the psychological stress that chronic pain causes.
Global and local market efforts - defining unique needs across markets
The first draft of the US blueprint had been defined by the time I joined the program. However, there were different needs across markets in the EU and Japan that impact both the process and form that the patient support program needs to take. In addition, some efforts were considered “global” — defined and driven by the global delivery team — and others “local” — identified and delivered by local country teams.
We ran a worksession with each country team at the annual Tanezumab conference in Florida in order to identify where the major areas of difference were for each country. In addition, we conducted a multi-day worksession with the Pfizer-Lilly team in Japan to ensure that Global solutions would accommodate the unique structure of both the medical system and social norms of both patients and providers
We worked with Pfizer/Lilly teams across the US, UK, Germany, Italy, France, Spain and Japan to identify the market-specific dependencies that would affect the planning and delivery of the patient support program.
The optimal experience flow was defined for each market, taking into account the unique needs and requirements of each market’s health system as well as social norms and expectations. See the full document here.
Championing a human-centered approach
Facilitating an experience-led conversation | Just as important as creating a human-centered experience was the introduction of tools, processes and vernacular to the organization. We encouraged “learning-by-doing” by having each person on the Pfizer-Lilly team participate in worksessions and conversations. We shaped our tools and materials so that conversations were experience-led, including workshop materials and video and audio recording.
CX Toolkit | With many teams across the globe working to implement both global and local solutions, we wanted to provide a reference resource that outlined the unique approach, rationale and guiding principles and frameworks that were used to create the patient support program. The CX Toolkit provides each team with supporting materials to create their own local programs, as well as insights from prior research which can be used to shape new opportunities.
View the toolkit here.
