Developing archetypes for key roles in a pragmatic trial: implementing human-centered design to promote advance care planning in primary care

Abstract Background: Archetypes are representations of a group of people with shared behaviors, attitudes, and characteristics. The design and use of archetypes have potential application to increase partnership and support when embedding and scaling interventions but methodological approaches have not been developed. Objective: To describe the methodology of designing archetypes for use in a pragmatic trial of advance care planning in the primary care context, SHARING Choices ((NCT04819191). We present resulting archetypes representing three key roles (primary care champion, advance care planning facilitator, and patient) in our pragmatic trial. Methods: Our process for developing archetypes involved 4 steps: 1) Identify roles for archetype development, 2) Identify Shareholders and Data Sources for Archetype Development, 3) Generate unique archetypes and their distinguishing traits, and 4) Iteratively refine archetypes through exposure, scrutiny, and shareholder input. We also developed a process map to communicate our methodology. Results: We created 6 distinct archetypes for the primary care champion role, 5 archetypes for the advance care planning facilitator role and 6 archetypes for the patient role. For each archetype we described strengths, challenges, prevailing emotions, and successful approaches to collaboration (e.g., “what works for me”). Unique opportunities for synergy between archetypes (such as with facilitator and champion) and potential challenges between archetypes (such as for facilitator and patient) suggest ways to improve training and support of key roles. Discussion: Our process for creating archetypes for use in implementation research was iterative and informative in discussion of implementation with shareholders. We expect this methodology to be useful for anticipating and analyzing many aspects of implementation.