Patient Experience Factors and Implications for Improvement Based on the Treatment Journey of Patients with Head and Neck Cancer

Simple Summary Understanding the patients’ problems is essential to improve their quality of life. Through interviews and observations with patients, caregivers, and medical staff, we aimed to identify the various issues experienced by head and neck cancer patients during the treatment process and suggest improvement directions. As a result, the patients wanted to obtain comprehensive and reliable information during the treatment process. The patient also wished the medical staff could explain things easily so they could understand. For continuing long-term treatment, it was important for medical staff to encourage the patients and build a relationship with them. To successfully treat head and neck cancer patients, we need to consider what information should be delivered, how we should provide it, and how we can encourage them to support their emotions. Abstract Based on the treatment journey, this study aimed to present insights into improving the patient-centered service experience for head and neck cancer (HNC) patients. We interviewed and observed patients, caregivers, and doctors. We conducted a qualitative content analysis and service clue analysis to identify barriers and enablers to patient care and to derive insights into the patient experience (PE). We received feedback from doctors considering the priority, importance, and feasibility of improvements and classified the insights into three service experience aspects, to suggest improvement directions. As a result, the ‘functional’ aspect of service experience stressed the importance of a comprehensive guide to the treatment process, delivery of reliable information, use of easy-to-understand terms, repeated summary explanations, the establishment of close and flexible linkages between departments, and the provision of educational programs. Regarding the ‘mechanic’ aspect, the use of large and clear visuals for patients, to easily understand the care information provided by medical staff was distinguished. In the ‘humanic’ aspect, patients’ psychological stability, trust in doctors, and doctor’s encouragement and support through maintaining a positive attitude were prioritized. This qualitative study provided integrative insights into the HNC patient experience, through the application of service design methodologies, such as a patient journey map, participatory research methods, and service experience clues.

medical staff to ask for opinions on the accuracy of terminology, the appropriateness of the content, and the logic of the analysis process. Feedback was reflected in the analysis results as soon as the feedback was received.

Phase 1-Patient Journey
Interviews were conducted with one specialist and two residents, to understand the treatment process. Based on the interviews, a JM of HNC patients was created, which  Interviews were conducted with doctors, patients, and caregivers, to understand the HNC treatment journey and identify specific actions, touchpoints, and emotions for each journey stage. Interviewees were directly recruited by an otolaryngology specialist from outpatients who had been diagnosed with head and neck cancer. The doctor introduced the purpose and content of the study to the patient and briefly explained the purpose and method of the interview. When the patient and guardian agreed to an interview, an in-depth interview was conducted immediately after outpatient treatment or on a different date. The interview was held in a separate private room in the hospital and lasted about an hour. The interviewees included all patients diagnosed with laryngeal, pharyngeal, or oral cancer who required surgery or were undergoing rehabilitation. The reason for this is that there is little difference in the treatment principles for each subsite, regarding the process that patients experience after treatment, problems and complications, and the needs of patients.
We also made observations during clinical counseling, to precisely understand the users' activities, physical space, and facility layout, including the furniture, doctor -patient interactions, objects being used, and users' attitudes and behaviors, if researcher participation was permitted. Based on the user research, a five-phased HNC treatment journey was structured. For the journey map, we identified the specific stages of the HNC treatment journey and analyzed the user's actions, emotions, and touchpoints related to each stage. The user's actions were indicated in the order of specific actions that occurred at each stage, and the emotions felt by the patient at each stage were described. A touchpoint is a point of contact where patients, caregivers, and medical staff interact. The touchpoints included various types, such as the pain and emotion of the patient, language to convey information, hospital system, image data, and explanation tools.
In the second phase, we took an inductive approach to analyzing the user research data. Qualitative content analysis and service clue analysis were applied to the semantic analysis of interview data, to understand the B/Es to PE. For the content analysis, following the method introduced by Graneheim and Lundman [27], we initially divided the full text of the transcript into meaning units matching the topic and purpose we wanted to know about and arranged each unit into a single sentence. A condensed meaning unit was then made by summarizing the keywords, including the manifest meaning unit, which summarizes the direct meaning, and the latent meaning unit, which grasps and interprets the latent meaning. The condensed meaning units were coded based on the core keywords of the semantic structure that was revealed directly or indirectly. The final coded units were plotted onto the JM by classifying negative and positive factors as barriers and enablers to PE. Each coding unit stage was decided considering the comprehensive relationship between the patient's treatment process, actions, touchpoints, and emotional state. The units were analyzed to determine which service clues corresponded to understanding the characteristics of the service areas to be improved. Finally, based on the identified B/E, we derived insights to improve the PE in phase three. The patient's B/E and interpreted insights were classified into three service experience aspects, to suggest improvement directions. We received doctor feedback to evaluate the improvement's priority, importance, and feasibility. For the feedback, we conducted three focus group meetings (one offline and two zoom meetings) and received frequent email feedback. In the first meeting, we reviewed the insights' appropriateness and discussed whether the patient's core needs were reflected at each journey stage. In the second meeting, key insights were selected by comprehensively reflecting on the medical service system at the hospital site, the frequency and importance of patient needs based on the patient treatment experience, and the perspectives of medical staff. At the third meeting, the appropriateness of the selected insights and the possibility of additional selections were reviewed, and finally the insights for improvement were confirmed. Confirmed insights were highlighted with **. In the middle of the three meetings, whenever necessary, an email was sent to the medical staff to ask for opinions on the accuracy of terminology, the appropriateness of the content, and the logic of the analysis process. Feedback was reflected in the analysis results as soon as the feedback was received.

Phase 1-Patient Journey
Interviews were conducted with one specialist and two residents, to understand the treatment process. Based on the interviews, a JM of HNC patients was created, which consisted of five stages: 'studies for cancer diagnosis and staging'; 'pre-operative counseling'; 'getting operation consent'; 'surgery and recovery'; and 'rehabilitation and follow-up' (Figure 1). We also conducted six interviews, five recordings, and two participatory observations with patients and caregivers, to understand the primary touchpoints, actions, and emotions during the patient's treatment journey. Table 2 summarizes the patient's primary actions, emotions, and touchpoints at each stage. Stage 1 (studies for cancer diagnosis and staging) involved four actions: recognizing symptoms, visiting the hospital/consulting, running studies for staging, and checking results/being diagnosed with cancer. As main touchpoints for this stage, the website for navigating cancer information, verbal language between patient and doctor, biopsy and imaging studies for cancer diagnosis, doctor's attitude toward patients, and patient's physical pain were identified. Stage 2 (pre-operative counseling) involved four actions (determining treatment methods, explaining and discussing the treatment, and deciding/planning the schedule) and seven touchpoints (evaluation report, body language used by the patient or verbal language between patient and doctor, visual material being used to explain the treatment, doctor's attitude toward patients, patient's pain, and hospital system to manage treatment schedule). Stage 3 (getting operation consent) involved four actions (entering the consulting room to sign the operation consent, explaining the surgical process and method, asking questions and answers regarding the consent, and signing the consent), and six touchpoints (consulting room, hand drawings, and image data used to explain the operation consent, body language and verbal language between patient and doctor, and consent paper form). Stage 4 (surgery and recovery) involved three actions (being hospitalized for surgery, recovering after surgery, and consulting other departments), and six touchpoints (doctor's verbal language, treatment cost, visual material to check the patient's condition, patient's pain after the surgery, doctor's attitude toward patients, and hospital system to support treatment cost and administrative guidance). Stage 5 (rehabilitation and follow-up) involved two actions (undergoing rehabilitation, visiting the hospital for follow-up check) and seven touchpoints (patient's pain, an education program for patient's self-care after discharge, hospital system for rehabilitation treatment and education, hospital location/facility, website for continuous information sharing, verbal language, and doctor's attitude toward patients).
The patient's emotions showed substantial negative aspects of anxiety and worry throughout the journey. In stage 2, it was found that the patient's trust in the doctor regarding the surgery revealed a positive desire for treatment. In stages 4 and 5, if the surgical results were good, the will to live was strongly formed as a positive emotion.

Phase 2-B/E to HNC PE
For each stage of the previously created JM, a content analysis of the data collected during user research was conducted to derive meaning units, which were classified into enablers as positive factors, and barriers as negative factors. Then, each factor was classified according to the corresponding touchpoint and what type of service clue corresponded to each was analyzed. Enablers correspond to a factor that is helpful or necessary to improve the patient's medical experience. This addresses aspects that need to be further strengthened for providing satisfying HNC PE in the future. On the other hand, barriers correspond to content where users complain of discomfort or have negative evaluations during the treatment process. This refers to the aspects that need to be improved for future PE. Table 3(1-5) introduce the enablers and barriers identified at each stage of the five treatment journeys. For each PE factor, the enablers and barriers related to specific actions and touchpoints at each stage were distinguished. Each factor was guided by including the coded source of the interview in parentheses. The service clue corresponding to each factor was identified and marked as (F) as functional clue, (M) as mechanic clue, and (H) as humanic clue. The final insights were derived by synthesizing enablers to overcome barriers. Each insight represents a factor that should be considered for improving the PE for each touchpoint. According to the attributes of each factor, the insights were categorized into information content, information delivery tool, information delivery method, hospital system, patient's pain, patient's feelings, doctor's attitude, treatment cost, education program, and hospital environment.         Table 3 containing the reference code numbers for each item is provided in Appendix A- Table A1).
For example, considering the touchpoint 'website' in Table 3(1), 'obtain reliable information from another channel' as an enabler, 'lack of information about relatively rare cancers', and 'fear of obtaining misinformation' were found as barriers to PE in stage 1. These three factors were related to 'obtaining information content', and insights into the 'need for reliable information delivery on relatively rare cancer' could be derived. As the insight related to the subject of 'information content' covers the functional technique of providing the PE service, it corresponds to the functional aspect among the three service clues.
The touchpoints of 'patient's emotion', 'anxiety and worries about life after surgery', and 'concerns about a long treatment journey' were found to be barriers to HNC PE. These two barriers correspond to 'patient's feelings'. They can be summarized as an insight into the 'need to alleviate anxiety and worry about the long-term treatment journey and life after surgery'. This insight represents a humanic clue, because it deals with the emotional aspect of humans.
The following insights were identified at each stage of the journey during the above analysis process.
Among these, 1 and 3 -7 correspond to the 'functional' aspects of improving PE, such as the content and method of information delivery and the hospital system. Insight 8 "It's the first time I've heard of cancer, so I wondered if it couldn't be done without an incision, and the names of cancers were so diverse and difficult that it was hard to understand. I didn't know anything, so I pretended to understand and said, 'Yes, please do well' when the professor said a lot." (1-1)

Stage 2
In Stage 2, 22 enablers to strengthen PE (12 functional clues, four mechanic clues, and six humanic clues) and 12 barriers to be improved (five functional clues, three me-chanic clues, and four humanic clues) were identified. The synthesized result revealed 17 insights (nine functional clues, two mechanic clues, and six humanic clues) as shown in Table 3 Of these, 1 -4 , 6 -7 , and 13 -15 relate to the 'functional' aspect regarding the content and method of information delivery and the hospital system. Points 5 and 8 relate to tangible tools corresponding to the 'mechanic' aspects; 9 -12 and 16 -17 concern the interaction between the doctor and the patient, representing the 'humanic' aspect.
2 "I think it would be comfortable if the doctor explained, 'You're in this condition now, but it will change like this in the future.' I wonder how long the surgery will take, whether I can return to my daily life after surgery, how the evaluation test is conducted, and whether there is a ward to be hospitalized. It would be nice if the doctor could tell me about how many rounds of chemotherapy should be done after surgery." (2-3a) 5 "It was nice that the doctor looked at my condition through an endoscope to see if I had healed well and explained it well. However, it was difficult to understand the explanation with CT images." (2-17a) 9 "We know it's the worst, but when the doctor speaks negatively, we lose heart. We hope to be at least a little hopeful." (2-2b)
Of these, 3 -7 , 11 , and 13 relate to the content and method of information delivery, representing the 'functional' aspects; 1 -2 , 8 , 12 , and 14 correspond to the 'mechanic' aspects, dealing with hospital environment, such as space and furniture arrangement; and 9 -10 are related to the interaction between the doctor and the patient, representing the 'humanic' aspect.
3 "The doctor gave an explanation that is difficult to understand at once, but it seemed important. But all of them were hard to understand, so I didn't even know what was more important, and it was not even in my head. If that's the case, I think focusing on what's really important is better." (3-6b) 8 "The text on the consent form was too small to read, the terms were difficult to pronounce, and the explanation took too long. I understood it at first, but later I couldn't remember anything. I couldn't even find a place to sign it, so the doctor marked it for me." (3-2b) 9 "From the day I found out he had cancer, I think I am also a cancer patient. I can't even tell you how hard it was mentally, very much." (3-3b)
Among these, 1 -4 and 10 correspond to the content of information delivery and the hospital system, representing the 'functional' aspects; 5 and 12 -13 relate to the provision and use of physical tools, engaging in the 'mechanic' aspect; and 2 , 6 -9 , and 11 ,relate to patient psychology and pain and present insights for improving PE, representing the 'humanic' aspect.
1 "My brother was in the integrated nursing ward for a month, but I couldn't visit even once because of COVID-19. So, the nurses in charge informed me of the patient's condition in detail by text message every evening. I thank them so much." (4-12) 12 "Even the slightest change in the symptoms after the surgery scared me, and I was worried about whether this was normal or a complication. I wish the doctor would let me know in advance that the symptoms will change like this in the future and what is normal." (4-13)
Of these, 4 -11 correspond to the 'functional' aspects, such as information delivery content, hospital system, and educational programs; 12 -14 relate to physical means, tools, and environments, representing 'mechanic' aspects; and 1 -3 and 15 -17 explain the 'humanic' aspects, dealing with patient's negative feelings and doctor's empathetic attitude.
5 " No detailed guidance was provided on how to behave and rehabilitate after discharge. I only heard that I should quit drinking and smoking and exercise regularly. That was all I got from the hospital." (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) 12 "In fact, if it's the same way, I'm better off closer to home." (5-16) 1 "The first time I visited the professor after discharge, he encouraged me to say that I had endured the difficult surgery well. He helped and encouraged me a lot. The professor did well with the surgery, so I should have hope while receiving rehabilitation treatment." (5-3a, 5-4, 5-7, 5-8b) The result of visually structuring using a JM, by synthesizing the above analysis, is shown in Figure 2, and the JMs for each stage correspond to Figure 3(1-5).

Phase 3-Insights by Service Clue Type
In this phase, by reclassifying the PE factors and the related insights identified in phase 2 into the three types of service clues, according to the attributes of the factors, we tried to identify which factors should be considered for PE improvement and what are the implications for improving HNC PE by service clue type. To this end, the ten PE factor categories classified using the attributes were divided into three service clue types. The critical insights derived at each stage of the treatment journey were summarized according to each service clue and factor type, as shown in Table 4. The implications for PE improvement from relating the PE factor derived for each of the three service clue types to the journey stage were as follows.

Functional
Information content (S1) ** Reliable information delivery on relatively rare cancers (S1) ** Comprehensive guide to the overall treatment process, including the cause of cancer, the necessity and process of the evaluation procedure, postoperative rehabilitation treatment methods, and surgical procedures and duration (S1) Guidance on how to shorten the evaluation period and give options  (S1) Alleviating the psychological shock of patients following cancer diagnosis (S1) Relief of anxiety and worry about long-term treatment journey and post-surgery life  Table 4 containing the reference code numbers for each item is provided in Appendix A- Table A2).
The 'functional' clue dealing with the technical aspect of providing a specific service for improving PE included five PE factors: information delivery content, information delivery method, hospital system, treatment cost, and education program. In information delivery contents, a comprehensive guidance of information related to the overall journey process consisting of five stages was required. For the information delivery method, easyto-understand terms for patients in journey Stages 1-3, where many explanations about treatment methods and processes are made to the patient, were highlighted. In hospital system, links and communication between departments were emphasized for Stages 1, 4, and 5, to reduce patient waiting times and ensure the consistent delivery of treatment information, in consultation with other departments. In Stage 2, a customized support service for the patient that considered patient circumstances was required, along with a text message service, enabling interactions between the patient, caregiver, and medical staff and for updating the patient's pre-operative study results. In Stage 5, an additional consultation window with the medical staff, patient continuous communication with the medical staff through administrative support, and discomfort minimization during the long-term treatment process were identified as important issues. Regarding treatment costs, government and insurance support were particularly emphasized in Stage 4. In Stage 5, educational programs were emphasized, regarding providing smoking cessation and abstinence programs, cases of overcoming cancer in other patients, and the latest HNC treatment technology trends.
The 'mechanic' clue, dealing with objects or environments perceptible by the senses, for improving PE was related to information delivery tools and the hospital environment. For information delivery tools, a reliable and easily accessible information delivery medium was identified as necessary in Stages 1, 4, and 5. Patients wanted as much information about treatment as possible in the early cancer diagnosis and recovery stages after surgery. In Stages 2-4, the use of clear and visible visual data that elderly patient could easily understand was emphasized. Stages 2 and 3 required a communication tool that could replace language, considering patients with difficulty in communicating verbally. In Stage 4, before and after surgery, a flexible communication tool or medium that enabled active information sharing and emotional expression among patients, caregivers, and medical staff was required. Regarding the hospital environment, in Stage 3, securing an independent counseling space for patient stability and interaction with the doctor was necessary. Thus, the arrangement of space and furniture to improve and support interactions between the patient and the doctor and help the patient focus on obtaining operation consent should be considered. In Stage 5, according to the prolonged rehabilitation treatment, it was necessary to establish convenient means of transportation and a comfortable treatment environment, considering patient convenience.
The 'humanic' aspect of PE dealing with user interactions, attitudes, emotions, and behaviors included needs related to the patient's pain, patient's feelings, and doctor attitudes. In patient's pain, attention to nutrition supply, preparation of countermeasures, and active response to patient pain after surgery were required in Stages 4 and 5. Regarding patient's feelings, active support and encouragement from caregivers and medical staff were needed. It was also necessary for the patient to understand the treatment journey in advance, by guiding them through detailed information for each stage, to alleviate negative emotions and maintain emotional stability. Empathy and encouragement of the caregiver's grievances about caring for the patient after discharge were also crucial in Stages 4 and 5. In Stages 2 and 5, maintaining a positive attitude toward treatment by building trust with the doctor helps increase patient satisfaction with the PE. For doctor's attitude, at all stages of the journey, except for Stage 3, the positive attitude of the medical staff, empathy, and encouragement of the patient played a vital role in the PE.
Above, we considered the PE factors and related insights that should be considered to improve HNC PE by service clue type. The insights for each stage of the journey presented in Table 4 reflect the perspectives of patients, caregivers, and medical staff involved in the HNC treatment journey, and it can be seen that various factors should be considered for each service clue.
We conducted three focus group meetings with HNC doctors to identify the relative importance of the factors that should be considered for improving HNC PE. We received feedback on the priorities and importance of the PE factors and related insights from two highly experienced HNC doctors, who both closely directly or indirectly interact with patients and fully understand their situation and needs. As a result, six insights were evaluated as necessary for the functional clue about information content. Three insights for information delivery methods, two for the hospital system, and two for the education program were evaluated as significant. Regarding the mechanic clue, the 'use of large and clear visuals that are easy to understand and recognizable by older patients' was evaluated as necessary for the information delivery tool. For the humanic aspect, three insights related to the patient's feelings and three insights related to the doctor's attitude were each evaluated as significant. The PE factors evaluated as relatively necessary during the feedback are marked with ** in Table 4.
Considering these feedback results, the information content that patients acquire during the treatment process is critical to improving the experience of HNC patients. In addition to the method of delivery of this information content, the painful emotions felt by patients during the treatment process, and the positive attitude of medical staff who respond appropriately to them can also be interpreted as key.
In summary, the early stages of the journey (S1-S3) involved the patient's cancer diagnosis and treatment method delivery (Table 4). Thus, using terms that the patient could easily understand or using visual materials was necessary. Comprehensive guidance for the overall treatment process must be provided from the early stage of the journey. In the later stages (S4-S5) related to the rehabilitation after surgery, as the frequency of contact between the doctor and the patient decreases, the burden on the patient to self-manage increases. Therefore, the preparation of rehabilitation guidelines and educational programs was emphasized. Encouragement and empathy for patient anxiety were required at all journey stages. The need for an information delivery medium that the patient can always find easily was highlighted (Figure 3. (1)-(5)).

Discussion
In this study, the following results were derived through a three-phased process. In phase 1, user interviews and participatory observation identified a five-staged HNC treatment journey process. For each stage, relevant user experiences were collected, including main actions, touchpoints, and patient emotions.
In phase 2, the barriers and enablers of PE were analyzed for each journey stage through content analysis of the collected user research data. As a result, ten insights were derived from 13 enablers and 11 barriers in the first stage. In stage 2, 17 insights emerged from 22 enablers and 12 barriers. In stage 3, 14 insights were derived from seven enablers and 20 barriers. In stage 4, 13 insights were identified from 12 enablers and 12 barriers. In stage 5, 17 insights were derived from 14 enablers and 13 barriers.
In phase 3, the insights derived from each stage were classified according to the three service clue types and categories of PE factors. The 'functional' aspect of service experience included five categories and 40 insights, stressing the importance of a comprehensive guide to the treatment process, delivery of reliable information, use of the easy-to-understand terms, repeated summary explanation, the establishment of close and flexible linkages between departments, and provision of educational programs (smoking/alcohol, and cancer survivor patient stories). Regarding the 'mechanic' aspect, two categories and 15 insights were included, such as using large and clear visuals that patients can understand easily. Three categories and 23 insights were included in the 'humanic' aspect, highlighting patient's psychological stability, trust in doctors, and doctor's encouragement and support by maintaining a positive attitude.
First, for the 'functional' aspect, regarding information content, the overall process of the treatment journey for HNC patients should be guided in the early stages of the journey. As framing the holistic picture of the journey from the patient's perspective (who must undergo a long-term treatment process) can help maintain emotional stability, the information content a patient needs at each journey stage is different. Thus, the information provided at each stage should be classified. An integrated database should also be established to provide the information for each category and to patients in a JM, where the treatment journey can be easily identified.
Second, as part of the 'functional' aspect, to maintain long-term and continuous treatment, educational programs should be provided in which patients can participate or receive information after discharge. Through providing a rehabilitation guide booklet and smoking cessation and sobriety education programs that can be referenced after discharge, information for continuous rehabilitation and self-management should be delivered to patients needing psychological support.
Third, with regard to the 'mechanic' aspect, stages 1-3 are when a patient first encounters HNC and is inundated with information. For elderly patients with reduced memory, a means to understand and accept information more efficiently is needed. As it is difficult for these patients to understand treatment information verbally, regarding information delivery methods and tools, large and clear visual data, such as human body models or illustration images, should be used as additional explanatory tools.
Fourth, regarding the 'humanic' aspect, HNC is a relatively rare cancer that requires long-term and complex treatment, and most patients experience depression and anxiety. To support patient emotions and to alleviate patient anxiety and worries, as well as to encourage a hopeful attitude throughout the treatment process, a video about overcoming cancer or a community for HNC patients could be provided for information exchange and psychological support between patients.
We conducted a convergence study of the medicine and service design by applying the JM methodology. As a result, we could reveal PE barriers and enablers that medical staff were perhaps unaware of. In addition, it was possible to derive realistic improvements through close interaction with the medical staff. As a result of our study, various items at each stage of the HNC patient's journey were identified as factors related to patient experience improvements, including functional aspects such as information and systems, mechanic aspects related to specific objects or facilities to support function, and humanic aspects such as the emotions and attitudes of patients and caregivers. This aligns with previous research [5], which revealed that PCC includes various aspects, such as the hospital system, patient-doctor information and communication, and caregiver support. Furthermore, the significance of this study rests in it identifying and introducing more specific factors for PE improvement. In addition, using a JM, the patient interview and observation data were embodied and visually displayed for each stage of the journey. This helped in understanding the intangible patient needs data. This shows that our results are meaningful, as a case study supporting the assertion of previous studies [3,8,[17][18][19]] that a JM helps convert intangible data into concrete structures. It also supported the usefulness of JMs as a methodology for improving health care.
Since this study conducted interviews with a small number of patients and caregivers, it is difficult to generalize the results. However, a qualitative research analysis was employed to discover in-depth insights into the patients, by conducting repeated observations and interviews over the journey stages for a small group of users who fit the purpose of the study. As Nielsen et al. [28] mentioned, rather than conducting a single study with many people, it is more effective to repeatedly collect and evaluate data with a small number of people, thus supporting the approach of this study. Lastly, this study was targeted at HNC patients, and the research scope could be expanded to other cancer fields or general cancer patients.

Conclusions
Applying service design to the medical field is a critical strategy for providing quality care from a patient's perspective. Since the patient's journey is complex and includes diverse aspects, it is essential to interpret the various viewpoints and complex data delicately. A JM is a valuable tool for understanding the relationships and patterns between meanings, by visually structuring complex patient needs. Thus, it is of great help to holistically understand where and how the patient's treatment experience occurs for each journey. Employing a qualitative methodology that collects patient needs through interviews and observations and systematically analyzing the contents through an inductive approach can provide more in-depth insights than the quantitative measurement of patient satisfaction. The results of this study can be used as reference materials for researchers interested in creative methodologies for improving PE.
By applying the creative methodology of service design, we employed three integrated perspectives to improve the experience of HNC patients. First, rather than dividing the treatment journey of HNC patients into fractured stages, the overall journey flow was examined in an integrated manner, to identify the changes and differences in the patient's needs at each stage. Second, to improve HNC PE, the perspectives of caregivers and medical staff, and the patient's perspectives were, directly and indirectly, reflected through a participatory method. Third, to identify the implications for improvement, three aspects of technical support, tangible tools, and human interactions were integrated and viewed, by applying three service experience clues: functional, mechanic, and humanic.