commentary
Responding to “Building bridges: Connecting virtual teams using narrative and technology”
Printable version
As a case study that may illuminate some of the complexities of online communication posed in this article, I will discuss a project involving healthcare communication, technical communication, usability, medical research, and graphic and interactive design specialists, which has taken place at two research centers in the University of Memphis and the pediatric oncology department at St. Jude Children's Research Hospital in Memphis, TN (Kim, Schmidt, Young, Popham, Barfield, Richter, & Camp, in review 2006). One of the factors of interactive design we explore in this project is the way in which narrative form might support a "distributed team" in a medical setting of pediatric cancer research—minor patients, their parents, physicians, and non-physician healthcare providers at St. Jude. [This definition of "distributed team" is somewhat different from the definition proposed by Fiore and McDaniel, in that it starts from the need to bridge roles and perspectives, rather than starting from the need to bridge physical distances. -Eds.]
What is informed consent?
Informed consent meetings in medicine, convened before any medical therapeutic intervention or research trial takes place in the U.S., aim to protect patients by helping them to understand the procedural details and the related risks and benefits of either the proposed intervention, or the patients' proposed participation in research. Typically taking place in a sit-down meeting prior to the procedure, patients and their parents receive a formidable amount of highly technical information in writing, and which they are presumed to understand in order to make the decision for their child to participate or not. When informed consent involves parents who are making decisions for their children with cancer, it is reasonable to assume the decision-makers are functioning under high levels of emotional stress—not the ideal environment for information processing. In addition, the developers regard the ethical imperative to present the information in an accurate, but accessible way, as one of the primary design challenges in the interface.
Redefining the informed consent process by distributing the team
Our proposal to improve the informed consent process as it stands, then, is to actually extend the process beyond the traditional face-to-face, sit-down meeting, by moving much of the information exchange online through a handheld device that delivers the information through text, graphics, sound, and animation (see Figure 1). The interactive device will not eliminate the sit-down meeting (during which parents make their decision), but it will enable parents to access and manage the information prior to the decision-making event, and to do so based on individualized preferences.
Figure 1: Opening screen for informed consent interactive device.
In terms of distributed work, our perspective is somewhat different from the problem scenario framed by Fiore & McDaniels, in which the online environment is used in lieu of a shared physical location. Instead, we distribute work across a team that has and will retain physical meetings. But by doing so, we believe we can better support the informed consent process, both to redefine the process and, at the same time, take advantage of the technology to distribute some of the group's work so that all members can have sufficient time and access to information vital for them to participate.
The current, early stage of interface development discussed here focuses on one of the four groups of participants--the parents--and is designed with their input to better identify the cognitive and socio-emotive needs that should be met during the process. As we have developed the interface, we have focused using narrative effectively, both in written and pictoral form. For example, as Young notes (2000), coherence in an interactive system is a necessary design consideration for offering meaningful, understandable information. In a prior study of visual narrative in an interactive show on brain science (Kim, 2005) I noted that viewers monitored color, shapes, and patterns, as they viewed sequential screens of a visual narrative in paper prototype. Doing so seemed essential for users to keep their place in the narrative and to link the visual information together, and this process seemed especially important when subjects were traveling into graphically less familiar ground (see Figure 2). Such a function of color and pattern in a visually presented narrative can be likened to readers benefiting from linguistic coherence, or the textual information and linguistic mechanisms that hold a written story together and advance the reader through the narrative's components.
Figure 2: Images from an interactive show on the brain, in which tracking colors, shapes, and patterns helped users maintain a sense of the visual narrative.
In the usability test of the brain show, viewers did not control the narrative thread as they do in the current project's informed consent interface, and the passages they looked at lacked any verbal information, whereas in the informed consent interface, we include text, images and other graphic elements, animation, and voiceovers. However, because the content in the informed consent interface is technical and new or difficult for at least some of the parents, we expect that by giving visual cues, such as applying consistent color to elements on the screens within the same topic of information, we will build visual coherence that will help carry the user through the multimodal narrative. (See the examples shown in Figure 3.)
Figure 3: Informed consent interactive device: Color signaled in the index of topics screen is carried throughout consequent screens of information within that topic.
Multiple perspectives offer ethically balanced information, improved narrative
In addition to designing for visual coherence, we offer multiple perspectives when possible on given chunks of information. Initially, we struggled with the idea that we could adopt an ethically neutral stance in delivering the information, by using the "transparent" and presumedly neutral writing style usually used in technical communication. We asked ourselves if this was sufficient to accomplish our goal to reach an ethical presentation of information. An accurate and ethical presentation of information is critical, as the physicians at St. Jude who care for the patients are also researchers. Eventually in our development discussions, the notion emerged that for readers, a speaker always exists behind the information, and so we should design for a fuller range of voices to be included. Thus, perspectives from each of the participant groups in the informed consent process (patient, parents, physician, allied healthcare provider) are given whenever possible, and the user can access them by clicking on the icon of the participant in the toolbar (see Figure 4).
Figure 4. Informed consent interactive device: Informed consent participant icon in toolbar signals multiple perspectives on this information are available. When icon is clicked, the perspective appears.
The multiple perspectives we offer were taken directly from responses the participants gave during focus groups held in the beginning of the project. Various aspects can convey not only a richer sense of the information in order to create a richer, more effective narrative which helps develop the socio-emotional bonds among group members, but helps us to separate and identify more explicitly, who each of the participants is and what their viewpoints (and possible agendas) are for the information.
Further development and research is ongoing, and user-testing for visual narrative coherence, and levels of trust of the text narratives will be measured.
References
Daft, R. L., & Lengel, R.H. (1986). Organizational information requirements, media richness, and structural design. Management Science, 554-571.
Fiore, S. M., & McDaniel, R. (2006). Building bridges: Connecting virtual teams using narrative and technology. Retrieved February 13, 2006, from THEN Web site: http://thenjournal.org/commentary/95/
Kim, L. (May 2005).Tracing Visual Narratives: User-testing methodology for developing a multimedia museum show. Technical Communication 52 (2), 1-17.
Kim, L., Schmidt, M., Young, A. J., Popham, S., Barfield, R., Richter, J., & Camp, J. Designing for affect and ethics in medical decision making: Using focus group data to develop an interactive tool for informed consent. In review with Association for Computing Machinery Designing Interactive Systems, 2006.
Young, R. M. (2000). Creating interactive narrative structures: The potential for AI approaches. American Association for Artificial Intelligence. Retrieved January 15, 2006, from http://www.aaai.org
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