Requirements for a Sociotechnical Support System for the Critically Ill - A Qualitative Study on the Needs and Expectations of Patients, Relatives and Health Professionals

Mechanical ventilation and subsequent weaning from the respirator are linked to high levels of physical and emotional stress for critically ill patients. Due to the severity of illness, impact of sedatives and the endotracheal tube, these patients cannot orally express their feelings and needs. In clinical practice, effective tools to facilitate early communication and re-orientation in these patients are lacking. To address this lack, a multidisciplinary project was set up to develop an "Ambient System for Communication, Information and Control in Intensive Care" (ACTIVATE). The present study was the first step and aimed to identify needs and expectations of patients, relatives and health professionals regarding ACTIVATE. A qualitative study involving 16 patients recently weaned from a ventilator, 16 relatives and 34 health professionals was conducted. The results show that for patients the weaning period is dominated by unanswered needs for effective communication with health professionals and relatives. These needs include the desire to directly express physical symptoms, receive re-orienting information and get into touch with relatives. For large parts, these needs were confirmed by the relatives and the health professionals, although some were associated with a lesser relevance. In addition, all interviews revealed user-and context-specific requirements for the design and functionalities of ACTIVATE. The results highlight the strong need for an innovative sociotechnical system to facilitate early and effective communication with patients undergoing weaning. We derived typical communication needs to be supported by ACTIVATE as well as user-and context-specific design requirements and potential ethical, legal and social implications.