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

被引：35

作者：

Cox, Christopher E. ^{[1
,2
]}

Wysham, Nicholas G. ^{[1
,2
,3
]}

Walton, Brenda ^{[1
,2
]}

Jones, Derek ^{[1
,2
]}

Cass, Brian ^{[4
]}

Tobin, Maria ^{[4
]}

Jonsson, Mattias ^{[5
]}

Kahn, Jeremy M. ^{[6
]}

White, Douglas B. ^{[6
]}

Hough, Catherine L. ^{[7
]}

Lewis, Carmen L. ^{[8
]}

Carson, Shannon S. ^{[9
]}

机构：

[1] Duke Univ, Dept Med, Div Pulm & Crit Care Med, Durham, NC 27710 USA

[2] Duke Univ, Program Support People & Enhance Recovery, Durham, NC 27710 USA

[3] Duke Clin Res Inst, Ctr Learning Hlth Care, Durham, NC USA

[4] Univ N Carolina, Sheps Ctr Hlth Serv Res, Chapel Hill, NC USA

[5] Univ N Carolina, Lineberger Comprehens Canc Ctr, Chapel Hill, NC 27599 USA

[6] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Pittsburgh, PA USA

[7] Univ Washington, Dept Med, Div Pulm & Crit Care Med, Seattle, WA USA

[8] Univ Colorado, Dept Med, Div Gen Internal Med, Denver, CO USA

[9] Univ N Carolina, Dept Med, Div Pulm & Crit Care Med, Chapel Hill, NC USA

来源：

ANNALS OF INTENSIVE CARE | 2015年 / 5卷

关键词：

Critical illness; Usability; Patient reported outcomes; Patient-centeredness; Surrogate decision making; Decision aid; Decision support; Chronic critical illness; Prolonged mechanical ventilation; INTENSIVE-CARE UNITS; OF-LIFE CARE; CONSENSUS; END; OUTCOMES; SUS;

D O I：

10.1186/s13613-015-0045-0

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页数：9