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Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation.

Cox CE, Wysham NG, Walton B, Jones D, Cass B, Tobin M, Jonsson M, Kahn JM, White DB, Hough CL, Lewis CL, Carson SS - Ann Intensive Care (2015)

Bottom Line: A total of 93% of users reported a preference for electronic versus printed versions.The Web-based decision aid for ICU surrogate decision makers can facilitate highly individualized information sharing with excellent usability and acceptability.Decision aids that employ an electronic format such as eCODES represent a strategy that could enhance patient-clinician collaboration and decision making quality in intensive care.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC 27710 USA ; Program to Support People and Enhance Recovery, Duke University, Durham, NC USA.

ABSTRACT

Background: Web-based decision aids are increasingly important in medical research and clinical care. However, few have been studied in an intensive care unit setting. The objectives of this study were to develop a Web-based decision aid for family members of patients receiving prolonged mechanical ventilation and to evaluate its usability and acceptability.

Methods: Using an iterative process involving 48 critical illness survivors, family surrogate decision makers, and intensivists, we developed a Web-based decision aid addressing goals of care preferences for surrogate decision makers of patients with prolonged mechanical ventilation that could be either administered by study staff or completed independently by family members (Development Phase). After piloting the decision aid among 13 surrogate decision makers and seven intensivists, we assessed the decision aid's usability in the Evaluation Phase among a cohort of 30 surrogate decision makers using the Systems Usability Scale (SUS). Acceptability was assessed using measures of satisfaction and preference for electronic Collaborative Decision Support (eCODES) versus the original printed decision aid.

Results: The final decision aid, termed 'electronic Collaborative Decision Support', provides a framework for shared decision making, elicits relevant values and preferences, incorporates clinical data to personalize prognostic estimates generated from the ProVent prediction model, generates a printable document summarizing the user's interaction with the decision aid, and can digitally archive each user session. Usability was excellent (mean SUS, 80 ± 10) overall, but lower among those 56 years and older (73 ± 7) versus those who were younger (84 ± 9); p = 0.03. A total of 93% of users reported a preference for electronic versus printed versions.

Conclusions: The Web-based decision aid for ICU surrogate decision makers can facilitate highly individualized information sharing with excellent usability and acceptability. Decision aids that employ an electronic format such as eCODES represent a strategy that could enhance patient-clinician collaboration and decision making quality in intensive care.

No MeSH data available.


Related in: MedlinePlus

Overview of study. The development of eCODES, a Web-based prolonged mechanical ventilation decision aid, included extension of a data entry and management system to include a study staff-directed electronic decision aid adapted from a printed version. Development also included enhancing eCODES with a mobile functionality, allowing users to view it at their convenience in locations outside a hospital setting. The performance evaluation phase included a formal assessment of usability, acceptability, and feasibility.
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Fig1: Overview of study. The development of eCODES, a Web-based prolonged mechanical ventilation decision aid, included extension of a data entry and management system to include a study staff-directed electronic decision aid adapted from a printed version. Development also included enhancing eCODES with a mobile functionality, allowing users to view it at their convenience in locations outside a hospital setting. The performance evaluation phase included a formal assessment of usability, acceptability, and feasibility.

Mentions: This study includes two components, a Development Phase and an Evaluation Phase (Figure 1), completed over a period of nearly 3 years. In the Development Phase, we adapted our previously validated printed prolonged mechanical ventilation decision aid to create a Web-based version (eCODES). Family members who piloted eCODES provided written informed consent. In the Evaluation Phase, we measured eCODES’ usability, acceptability, and feasibility among family members of ICU patients. We conducted this phase under a waiver of consent granted by the Duke University Institutional Review Board because we did not record any personal information, only gender and age range. The timeline of the entire decision aid project including both the printed and Web-based versions is shown in Additional file 1: Figure S1 (“Evolution and development of web-based decision aid).Figure 1


Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation.

Cox CE, Wysham NG, Walton B, Jones D, Cass B, Tobin M, Jonsson M, Kahn JM, White DB, Hough CL, Lewis CL, Carson SS - Ann Intensive Care (2015)

Overview of study. The development of eCODES, a Web-based prolonged mechanical ventilation decision aid, included extension of a data entry and management system to include a study staff-directed electronic decision aid adapted from a printed version. Development also included enhancing eCODES with a mobile functionality, allowing users to view it at their convenience in locations outside a hospital setting. The performance evaluation phase included a formal assessment of usability, acceptability, and feasibility.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385299&req=5

Fig1: Overview of study. The development of eCODES, a Web-based prolonged mechanical ventilation decision aid, included extension of a data entry and management system to include a study staff-directed electronic decision aid adapted from a printed version. Development also included enhancing eCODES with a mobile functionality, allowing users to view it at their convenience in locations outside a hospital setting. The performance evaluation phase included a formal assessment of usability, acceptability, and feasibility.
Mentions: This study includes two components, a Development Phase and an Evaluation Phase (Figure 1), completed over a period of nearly 3 years. In the Development Phase, we adapted our previously validated printed prolonged mechanical ventilation decision aid to create a Web-based version (eCODES). Family members who piloted eCODES provided written informed consent. In the Evaluation Phase, we measured eCODES’ usability, acceptability, and feasibility among family members of ICU patients. We conducted this phase under a waiver of consent granted by the Duke University Institutional Review Board because we did not record any personal information, only gender and age range. The timeline of the entire decision aid project including both the printed and Web-based versions is shown in Additional file 1: Figure S1 (“Evolution and development of web-based decision aid).Figure 1

Bottom Line: A total of 93% of users reported a preference for electronic versus printed versions.The Web-based decision aid for ICU surrogate decision makers can facilitate highly individualized information sharing with excellent usability and acceptability.Decision aids that employ an electronic format such as eCODES represent a strategy that could enhance patient-clinician collaboration and decision making quality in intensive care.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC 27710 USA ; Program to Support People and Enhance Recovery, Duke University, Durham, NC USA.

ABSTRACT

Background: Web-based decision aids are increasingly important in medical research and clinical care. However, few have been studied in an intensive care unit setting. The objectives of this study were to develop a Web-based decision aid for family members of patients receiving prolonged mechanical ventilation and to evaluate its usability and acceptability.

Methods: Using an iterative process involving 48 critical illness survivors, family surrogate decision makers, and intensivists, we developed a Web-based decision aid addressing goals of care preferences for surrogate decision makers of patients with prolonged mechanical ventilation that could be either administered by study staff or completed independently by family members (Development Phase). After piloting the decision aid among 13 surrogate decision makers and seven intensivists, we assessed the decision aid's usability in the Evaluation Phase among a cohort of 30 surrogate decision makers using the Systems Usability Scale (SUS). Acceptability was assessed using measures of satisfaction and preference for electronic Collaborative Decision Support (eCODES) versus the original printed decision aid.

Results: The final decision aid, termed 'electronic Collaborative Decision Support', provides a framework for shared decision making, elicits relevant values and preferences, incorporates clinical data to personalize prognostic estimates generated from the ProVent prediction model, generates a printable document summarizing the user's interaction with the decision aid, and can digitally archive each user session. Usability was excellent (mean SUS, 80 ± 10) overall, but lower among those 56 years and older (73 ± 7) versus those who were younger (84 ± 9); p = 0.03. A total of 93% of users reported a preference for electronic versus printed versions.

Conclusions: The Web-based decision aid for ICU surrogate decision makers can facilitate highly individualized information sharing with excellent usability and acceptability. Decision aids that employ an electronic format such as eCODES represent a strategy that could enhance patient-clinician collaboration and decision making quality in intensive care.

No MeSH data available.


Related in: MedlinePlus