Addressing Polypharmacy: Developing Public-Facing Resources Through Storytelling-Based Co-Design

Abstract

Background: Tackling problematic polypharmacy is a global health safety priority and is likely to require a multifaceted approach. UK health policy hinges around the potential of medication reviews, but deprescribing in medication reviews is uncommon and evidence on how to harness their potential is sparse. Methods: Storytelling Group, a design-led methodology, was used to invite experts-by-experience (‘story-creators’) to re-imagine the medication review. We facilitated three 2-h workshops with seven story-creators, aged 65+ with experience of polypharmacy and an interest in identifying ways of safely reducing medications. Participants collaboratively built fictive scenarios, creating characters, chronology, contexts and plots, identifying touchpoints and incorporating personal experience. Provocative prompts (‘What ifs?’) aided story development. Results: Participants created five rich fictional narratives, featuring protagonists affected by polypharmacy and medication reviews involving new and different professionals, roles and contexts. Storytelling Group enabled experts-by-experience to use their knowledge of current medication review practices as their motivation to inspire novel imagined arrangements. This speculative exercise, deliberately crafted to distance participants from current realities, enabled them to share insights and propose new possibilities to address polypharmacy. The process revealed a range of tacit assumptions regarding the roles of healthcare professionals, patients, medications, the health system, and their inter-relationships. Only two of the five narratives they co-constructed involved deprescribing, neither in conventional clinical settings. We then curated a prototype collection of seven fictional short stories (‘Let’s Talk Differently About Medicines’) which we refined through user-experience testing. Conclusions: Our study is an empirical exploration of a design-led methodology which may be adapted for application in healthcare improvement when the phenomenon being addressed is sufficiently complex as to escape easy articulation or resolution.