Format

Send to

Choose Destination
J Crit Care. 2016 Jun;33:19-25. doi: 10.1016/j.jcrc.2016.01.030. Epub 2016 Mar 8.

Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.

Author information

1
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
2
Department of Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada; Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Research Centre of the CHU de Québec, Quebec City, Quebec, Canada.
3
Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
4
Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA.
5
Office of Healthcare Quality Improvement, Saint Clair Hospital, Pittsburgh, PA.
6
Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA.
7
Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
8
The Greenwall Foundation, New York, NY.
9
Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA.
10
Department of Medicine and Division of Hosiptal Medicine and Palliative Care Program, University of California San Francisco, San Francisco, CA.
11
Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA.
12
Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, MA.
13
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
14
Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: whitedb@upmc.edu.

Abstract

PURPOSE:

Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs.

METHODS:

We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews.

RESULTS:

Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy.

CONCLUSION:

There is broad support among stakeholders for the use of a tablet-based tool to improve communication and shared decision making in ICUs. Eliciting the perspectives of key stakeholders early in the design process yielded important insights to create a tool tailored to the needs of surrogates and care providers in ICUs.

KEYWORDS:

End-of-life; ICU communication; Qualitative; Surrogate decision makers; User-centered design

PMID:
27037049
DOI:
10.1016/j.jcrc.2016.01.030
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center