Foundational research and journey mapping across 40+ community oncologists and care team members, commissioned to understand why a clinically strong diagnostics portfolio was stalling in community practices, and what it would actually take to change that.
A clinically strong portfolio stalling in community practices, with the wrong theory about why
An oncology diagnostics company was preparing to scale its portfolio of liquid biopsy products into community practices across the U.S. Adoption was slower than expected. The internal working theory, shared across product, sales, and marketing, was consistent: oncologists didn't fully understand the superior science. The team assumed the answer was better education, more clinical data, and cleaner messaging.
The research told a different story entirely. One that required the them to question their original premise, not refine the product's pitch.
40+
community oncologists and care team members interviewed across customers and non-customers
3
guiding principles that reordered commercial and product priorities
1
reframe that shifted the strategy from education-led to workflow-first
Due to confidentiality constraints, product details have been generalized throughout. Artifacts shown are adapted from the original research deliverables and do not reproduce proprietary data or client-specific content.
The real barriers to adoption were operational, not epistemic. Oncologists understood the tests, but care teams found them difficult to order, track, and integrate. Workflows that required stepping outside the EMR created friction that no amount of physician interest could overcome. A vendor that was hard to use for the medical assistant would be abandoned by the practice, regardless of what the physician believed clinically.
Research across all participant groups made this unmistakably clear. The misalignment between the internal working theory and observed behavior wasn't minor. The reframe that followed wasn't a messaging adjustment. It restructured roadmap priorities, sales segmentation, and onboarding architecture.
What Teams Assumed
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Oncologists aren't adopting because they don't understand the science
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Clinical superiority is the primary decision driver
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Better education and messaging will move the needle
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One standard pitch works across all practice types
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Physician interest is sufficient to drive adoption
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Scientific head-to-head data is the main differentiator
What Research Revealed
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Clinical merit is table stakes; workflow fit decides adoption
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Care teams block vendor selection even when physicians want the product
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A difficult first 60 days predicts long-term abandonment
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Practice type predicts adoption behavior better than geography
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Operational ease is a clinical decision, not an IT one
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Every high-adoption account becomes a reference engine, if systematized
I led end-to-end foundational research structured across internal and external participants, designed to triangulate working assumptions against observed behavior and surface the gaps between them.
Research structure
12
Internal
Stakeholder interviews
Surface working assumptions and prior insights before external research began. Established the internal theory as a baseline to challenge.
ProductSalesMarketingMed affairsTech
10
Field
Sales rep interviews
Critical bridging perspective: direct visibility into how practices actually behaved, often in tension with internal narratives.
West CoastEast CoastSouth
40+
External
Oncologist and care team interviews
Customers and non-customers. Clinical workflow, vendor selection, ordering logistics, EMR integration, and the unspoken drivers of day-to-day decisions.
OncologistsMAsNursesOffice managers
ⓘ
One consistent signal
The barrier to adoption wasn't clinical understanding. It was operational fit.
Confirmed independently across internal stakeholders, field sales, and 40+ external participants.
☷
Competitor digital footprint analysis
Touchpoint mapping across selection and monitoring use cases to benchmark the landscape.
✎
Cross-functional synthesis workshop
On-site session with product, ops, clinical, business, and marketing. Tailored worksheets per team.
Three principles that reordered commercial priorities
Derived from the consistent patterns observed across all participant groups, these principles reflect the deepest and most repeated needs uncovered. They outline a clear blueprint for how to engage, support, and earn trust in community oncology.
01
Prove the patient outcome, not just the science
Community oncologists are inundated with claims of clinical superiority. The message has become commoditized. To justify changing an established workflow and trusted vendor, they require a higher standard of evidence: proof that using a test leads to a tangible improvement in patient outcomes, not just a larger gene panel or a head-to-head sensitivity advantage. Without that, clinical interest stalls before it becomes adoption.
02
Remove administrative lift from the care teams
Care teams (office staff, MAs, nurses, NPs) are the operational backbone of any oncology practice. They manage the logistics of ordering, tracking, and reporting. Research showed they are powerful and consistently underestimated influencers in vendor selection. A difficult workflow for the care team can and will block adoption, sometimes even when the physician is clinically convinced. They have to be bought in more than the doctor.
03
Meet clinicians where they already work
The most consistent theme across all participants was a desire for smoother, more streamlined workflows. Because the EMR is the core clinical workspace, requiring teams to step outside it to order tests, track samples, or view results adds friction at every touchpoint. Reducing this friction isn't just a UX improvement. It's the difference between occasional use and embedded practice.
Five core artifacts structured the research output and aligned cross-functional partners around a shared understanding of the customer. Each was built to serve not just as a deliverable but as a live working document, used in the final workshop and carried forward as the foundation for ongoing strategy.
Artifact 01
Community Oncologist Journey Map
End-to-end map of the community oncologist experience across five clinical phases: referral through disease progression. Documented oncologist priorities, care team priorities, core tensions, and opportunity directions at each stage. Surfaced the critical friction points where vendor relationships are won or lost.
Artifact 02
Archetype Profiles
Two research-grounded archetypes (the Community Oncologist and the Care Team Member) built from direct interviews. Each profile captured goals, decision drivers, key frustrations, and representative voice. Used to personalize sales rep training and segment commercial messaging by role, not just by practice geography.
Artifact 03
JTBD Frameworks
Jobs-to-be-done analysis for both genomic testing and monitoring use cases, capturing the clinical scenarios that trigger ordering, the three pillars of utility, and five trigger scenarios where adoption was most likely. Reframed vendor positioning from product features toward clinical job fulfillment and workflow integration.
Artifact 04
Cross-Functional Workshop
On-site shareout and working session with product, operations, clinical, business, and marketing teams. Each group used tailored feedback worksheets aligned to the insights most relevant to their decisions. Produced a shared reframe of the adoption problem and a prioritized set of opportunity directions that restructured roadmap and commercial planning.
Artifact 05
Digital Experience Gap Analysis
Side-by-side service blueprint comparing the white-glove sales team experience against the digital portal experience for both oncologists and care team members. Documented 5 structural gaps across onboarding, role recognition, support access, information format, and continuity. Used as the anchor artifact for the digital CX workstream.
Science education programs de-prioritized. Commercial investment redirected toward workflow integration, onboarding infrastructure, and care team enablement, a direct reversal of the prior go-to-market thesis. Messaging architecture rebuilt around operational fit, not clinical data volume.
Roadmap
EMR integration and longitudinal report design advanced to the top of the product roadmap. Both had been passed over in favor of expanding clinical data, until the research produced direct, participant-cited evidence for re-sequencing. The two highest-value unrealized opportunities in the portfolio were already known. They just hadn't been treated as urgent.
Sales
Playbook rebuilt from geography-based to practice-type segmentation. Care team influence mapping added to standard rep training. First-60-day onboarding redesigned as a structured program. The research identified that window as the highest-risk period for long-term abandonment, and no one had been actively managing it.
Organizational
Cross-functional teams worked from a shared customer baseline for the first time. Working assumptions that had persisted across product, sales, marketing, and clinical for years were surfaced, challenged, and replaced. The workshop didn't just share findings; it produced a common language for the customer that teams could build on rather than relitigate with each new initiative.
"Adoption hinges not just on clinical merit, but on how well solutions fit the messy, variable, and intensely human workflows of everyday cancer care. When tests and tools reduce friction, mirror real decision-making patterns, and support clinicians' natural ways of synthesizing information, they become not just preferable, but indispensable."
Every interview made the same thing clear: the physician signs off but isn't running the test logistics, the care team is. And the portal was designed as if only one of them existed.
Archetype 01
The Community Oncologist
Independent or health-system-affiliated · Stage III-IV solid tumors · Mixed-payer patient population
Core Goals
Make fast, confident treatment decisions. Protect patients from unnecessary anxiety or harm. Maintain clinical credibility with patients and peers without being slowed down by vendor complexity.
Primary Decision Drivers
Clinical utility: proof that a test changes patient outcomes, not just data. Actionability: a clear summary page that drives decisions in under 30 seconds. Turnaround time and guideline alignment for payer justification.
Key Frustrations
Tests that produce data without guidance on how to act on it. Longitudinal results requiring manual comparison across separate PDFs. Vendors who compete on scientific superiority rather than practical workflow fit.
"You've got to prove to me how it's better for my patient to act on that result, independent of anything else."
Community Oncologist, Research Interview
Archetype 02
The Care Team Member
Office staff, MAs, nurses, NPs · Operational backbone of the practice · High influence on vendor selection and retention
Core Goals
Keep workflows smooth and predictable under high daily volume. Avoid manual follow-up caused by opaque test tracking. Build vendor relationships that are reliable enough to run in the background, not managed constantly.
Primary Decision Drivers
Ease of ordering: fewest steps, fewest portals. Real-time order tracking from sample receipt through result delivery. Proactive, responsive rep support. Smooth onboarding that doesn't require retraining every six months.
Key Frustrations
No visibility into where a sample is or when results will arrive. Kit preparation steps that fall outside standard workflow. Inconsistent turnaround time that makes patient scheduling impossible to manage proactively.
"You have to have the care team totally bought in more than the doctor, and they have to be your voice for you when you're not there."
Sales Representative, Research Interview
In practice, each of these archetypes were further subdivided into personas.
The sales team was delivering white-glove service,
and the portal was delivering friction.
Oncologist and care team interviews surfaced a sharp disconnect: practices that had strong rep relationships were getting personalized, role-aware support at every step. Then they'd log into the portal and hit a generic, one-size-fits-all experience that treated the ordering physician and the office manager identically. No role distinction. No self-service. No chatbot or guided help. Their biggest friction point was a complex onboarding that nobody had designed for the people actually doing it.
Sales Team Experience
Digital Portal Experience
First Contact & Onboarding
Rep introduces the product in the context of the practice's specific workflow. Walks the physician through clinical use cases, walks the MA through ordering steps. Role-aware from day one.
Personalized
Single generic account setup flow. Same screens for oncologist, MA, nurse, and office manager. No branching, no role detection, no tailored guidance.
No Role Distinction
Role Recognition
Rep adapts the conversation in real time. Clinical efficacy framing for the physician. Ordering logistics and kit prep for the care team. Different priorities, different language.
Adaptive
Portal presents identical UI regardless of who is logged in. A physician sees the same dashboard as the MA running test orders. No persona-aware navigation, no role-based defaults.
No Persona Layer
Support Access
Direct phone and text access to a named rep. Issues resolved same day. Rep proactively checks in during the first 60 days, the highest-risk window for abandonment.
Proactive, Named Contact
Email or support ticket only. No chatbot, no self-service help, no in-app guidance. Response times variable. No proactive outreach built into the onboarding flow.
No Self-Service or Chatbot
Information Format
Rep curates what each role needs to know. Physician gets clinical summary and outcome data. Care team gets logistics: kit prep, shipping windows, result turnaround expectations.
Role-Curated
Same interface, same information density for every user type. Care team members navigating clinical documentation they don't need. Physicians looking for actionable summaries they can't find quickly.
Undifferentiated Content
Follow-Up & Continuity
Rep tracks usage patterns and follows up proactively if ordering drops. High-adoption accounts flagged as reference candidates. Relationship scales with the practice.
Continuous Relationship
No behavioral triggers, no proactive nudges, no longitudinal engagement design. If a user drops off, the portal doesn't know and doesn't respond.
No Behavioral Awareness
How Each Persona Experiences the Gap Differently
MD
The Community Oncologist
Physician, clinical decision-maker
With the Sales Rep
●Gets a curated clinical story tied to their patient population
●Outcome data framed around decision confidence, not raw panel size
●Named point of contact for questions; response is same-day
●Rep handles the care team coordination so they don't have to
In the Portal
●Lands in the same onboarding flow as office staff
●No clinical summary view; results require manual PDF comparison across visits
●No decision-support layer to make results immediately actionable
●No longitudinal trend view; has to reconcile data manually
MA
The Care Team Member
MA, nurse, office manager, operational gatekeeper
With the Sales Rep
●Rep walks through kit prep and ordering steps in person
●Direct line to rep for tracking questions and logistics issues
●First 60 days actively supported; rep checks in on workflow fit
●Rep relationship makes up for portal gaps through manual support
In the Portal
●Onboarding built for physicians; care team tasks buried or unlabeled
●No real-time order tracking; status requires calling support
●No self-service answers for common logistics questions
●If the rep relationship weakens, there is no digital fallback
The Structural Risk
The white-glove sales experience was masking the portal's failure modes. Every time a care team member hit friction in the digital flow, a rep absorbed it manually. That's not a scalable model. At any account without active rep coverage, the portal alone had to carry the relationship, and it couldn't.
Community oncologists move through a high-stakes journey defined by fragmented systems, unrelenting time pressure, and emotionally charged decisions. These friction points don't just shape their workflow; they shape which diagnostic and monitoring partners they trust, rely on, and ultimately adopt.
Cognitive & Operational Load Across the Oncologist Journey
Journey in Detail: Tensions and Opportunity Directions by Stage
Stage 01
Referral & Transition
Information gaps, fragmented records
Stage 02
Intake & Diagnosis
Speed urgency, concurrent testing decisions
Stage 03
Treatment Planning
△ Highest cognitive load
Stage 04
Treatment Surveillance
Uncertainty, no standardized thresholds
Stage 05
Disease Progression
△ Highest emotional weight
Oncologist Priorities
Triage urgency from incomplete records
Prepare diagnostic workup
Build early rapport with new patient
Oncologist Priorities
Confirm diagnosis and stage disease quickly
Order appropriate genomic testing
Minimize time-to-treatment-decision
Oncologist Priorities
Synthesize fragmented inputs into a clear regimen
Justify therapy selection to payer
Move quickly from data to decision
Oncologist Priorities
Detect response or progression early
Interpret molecular signals against imaging
Make confident continue/escalate decisions
Oncologist Priorities
Identify resistance or progression early
Select next treatment line efficiently
Manage patient expectations with clear data
Care Team Priorities
Reconcile outside records before first visit
Schedule pre-visit testing
Coordinate with referring practice
Care Team Priorities
Coordinate kit prep and requisitions
Manage blood draw logistics
Track sample shipping status
Care Team Priorities
Prepare prior auth and payer documentation
Coordinate multidisciplinary team logistics
Route genomic results to the right physician
Care Team Priorities
Coordinate serial blood draws on schedule
Route results to the physician inbox
Handle high volume of patient status calls
Care Team Priorities
Coordinate new line selection testing
Support patient and family communication
Manage complex scheduling logistics
Core Tension
Records arrive incomplete or late. Multiple unlinked systems force manual reconciliation before the first visit has even begun.
Core Tension
Clinicians fear missing a treatment window more than duplicating effort, leading to concurrent ordering to hedge against delays.
Core Tension
Non-actionable results waste scarce cognitive time without enabling a decision. Clinicians "satisfice," acting on whatever is available, not what's ideal.
Core Tension
Without guideline clarity, clinicians develop personal "rules of thumb" rather than systematic protocols, which are inconsistent, high-risk, and difficult to scale.
Core Tension
The emotional weight of decisions under uncertainty is at its peak. Clinicians must interpret complex data while managing patient anxiety, often without definitive guideline guidance.
Opportunity Direction
Position as a reliable accelerator for incomplete tissue, lowering staff cognitive strain from the very first ordering interaction.
Opportunity Direction
Deliver real-time transparency (status, expected timing, next steps) and make ordering simple enough that staff are never a blocker.
Opportunity Direction
Act as a synthesis partner, not just a data provider. Prioritized, actionable summaries plus payer-ready documentation removes the most common blockers at this stage.
Opportunity Direction
Make longitudinal data visually diagnosable at a glance. Interpretation guardrails and trend visualization reduce cognitive burden and enable confident decision-making.
Opportunity Direction
Deliver a closed-loop pathway: a proactive signal that drives early next-line testing, with a report designed for both clinical clarity and emotional safety at the hardest moments.
Critical Friction Moments
Stage 02-03 · Diagnosis & Treatment Planning
The Non-Actionable Result
Across all participant groups, results that couldn't clearly drive a decision were consistently described as worse than no result. The data wasn't the problem. The cognitive burden of having to act on ambiguity in a high-stakes, time-pressured environment. Actionability is not a feature. It is the product.
All Stages · Care Team Experience
The Invisible Gatekeeper
In practice after practice, vendor selection and retention was controlled not by the physician but by the MA, nurse, or office manager. A vendor that was hard to use for the care team (difficult ordering, opaque tracking, inconsistent turnaround) would be quietly deprioritized, then discontinued, regardless of clinical preference. The care team is the real buyer in community oncology.
Stage 04 · Treatment Surveillance
The Longitudinal Gap
Clinicians were manually comparing separate PDFs, tracking changes in notebooks, and reconciling reports across visits. This was universal, labor-intensive, and error-prone. It was also a direct product gap, and the single highest-value unrealized opportunity identified in the research. A unified longitudinal view was the "magic wand" request that appeared, unprompted, across nearly every oncologist interview.
Practices come in curious, and leave the first order with real frustration. Portal onboarding is generic, kit logistics are confusing, and nobody from the digital side checks in. The satisfaction drop is sharp and it's earned. Whether a practice orders again depends entirely on whether the rep relationship held, not whether the product worked.
Using an impact-effort matrix to sequence the portfolio of opportunities from the research. EMR integration is the right long-term bet, but practices could feel the difference from real-time tracking in a sprint.
High ImpactLow Impact
Quick Wins
Real-time order status on portal home
Chatbot for top status questions
Practice-type segmented sales playbook
Strategic Bets
EMR integration (bidirectional)
Persona-aware onboarding by role
Longitudinal report view
Fill-Ins
Proactive result-ready email alerts
One-page report summary layer
Deprioritize
Conference-only education campaign
Generic social media awareness
Low EffortHigh Effort
The research didn't just describe problems; it pointed toward specific moves. Each direction below is grounded in a behavior observed across multiple participant groups, not an assumption or hypothesis.
1
Reframe the core problem
What research showed: Oncologists could accurately describe the technology, the mechanism, and the clinical rationale. They weren't confused about the science. They were stuck in the workflow. Ordering was cumbersome, tracking was opaque, results required manual interpretation with no decision support. Implication: Clinical superiority messaging targets the wrong problem. The commercial strategy should lead with operational fit, not scientific differentiation.
2
Target care teams, not just physicians
What research showed: In practice after practice, vendor selection and quiet discontinuation was driven by MAs, nurses, and office managers, not physicians. A test could have a clinician's full clinical confidence and still be abandoned because the staff couldn't work it into their day. The care team doesn't just support adoption; they control it. Implication: Any sales motion, onboarding design, or retention strategy that doesn't explicitly target care team buy-in is optimizing for the wrong decision-maker.
3
Build for longitudinal visibility
What research showed: Clinicians were manually comparing PDFs across visits, tracking trends in notebooks, and building workarounds nobody had asked them to build. It was universal, cumbersome, and completely avoidable, and no vendor in the space had solved it. When asked what they'd change most about their current testing experience, a unified longitudinal view came up unprompted across nearly every oncologist interview. Implication: This is the highest-value unbuilt feature in the space. It's a clinical necessity being met by Excel.
4
Segment by practice type
What research showed: Practice type (independent vs. health-system-affiliated, high-volume vs. focused, fax-centric vs. EMR-first) predicted adoption behavior and friction points more reliably than geography, specialty, or physician demographics. The same pitch landed completely differently depending on practice context. Implication: A universal commercial approach creates unnecessary friction where segmentation would create relevance. Sales messaging, onboarding support, and rep training should be calibrated to practice type as a primary variable.
5
Systematize the reference engine
What research showed: The single most consistent driver of new-account adoption was a trusted peer who had already adopted. A colleague at a comparable practice, speaking to the real experience. This was happening organically at high-adoption accounts. It was not being designed, tracked, or activated. Implication: Every strong first-60-day experience is a latent reference asset. Building a structured peer reference program, and redesigning onboarding to produce the outcomes that make it credible, is one of the highest-ROI investments available.
Client identity, product names, and proprietary data have been generalized throughout. Artifacts shown are adapted from the original research deliverables and do not reproduce client-specific content.
