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PLoS One. 2018 Feb 15;13(2):e0191844. doi: 10.1371/journal.pone.0191844. eCollection 2018.

Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping.

Author information

1
Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
2
Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
3
Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Institut universitaire de première ligne en santé et services sociaux, Université Laval, Québec, QC, Canada.
4
Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada.
5
Population Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.
6
Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
7
School of Nursing and Centre for Health Services and Policy Research University of British Colombia, Vancouver, BC, Canada.
8
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
9
Department of Critical Care, Queen's University, Kingston, ON, Canada.
10
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America.
11
Faculty of Nursing, Université Laval, Québec, QC, Canada.
12
Institut universitaire de cardiologie et pneumologie de Québec, Québec, QC, Canada.
13
Department of Information and Communications, Faculty of Arts and Human Sciences, Université Laval, Québec, QC, Canada.
14
Faculty of Medicine, Université Laval, Québec, QC, Canada.
15
Department of Anesthesiology and Critical Care Medicine, Intensive Care Division, Faculty of Medicine, Université Laval, Québec, QC, Canada.

Abstract

BACKGROUND:

Upon admission to an intensive care unit (ICU), all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients.

OBJECTIVES:

To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient's risk factors; and to document the use of a wiki platform for this purpose.

METHODS:

We conducted three weeks of ethnographic observation in our ICU to observe intensivists and patients discussing goals of care and to identify their needs regarding decision making. We interviewed intensivists individually. Then we conducted three rounds of rapid prototyping involving 15 patients and 11 health professionals. We recorded and analyzed all discussions, interviews and comments, and collected sociodemographic data. Using a wiki, a website that allows multiple users to contribute or edit content, we adapted the decision aid accordingly and added the Good Outcome Following Attempted Resuscitation (GO-FAR) prediction rule calculator.

RESULTS:

We added discussion of invasive mechanical ventilation. The final decision aid comprises values clarification, risks and benefits of CPR and invasive mechanical ventilation, statistics about CPR, and a synthesis section. We added the GO-FAR prediction calculator as an online adjunct to the decision aid. Although three rounds of rapid prototyping simplified the information in the decision aid, 60% (n = 3/5) of the patients involved in the last cycle still did not understand its purpose.

CONCLUSIONS:

Wikis and user-centered design can be used to adapt decision aids to users' needs and local contexts. Our wiki platform allows other centers to adapt our tools, reducing duplication and accelerating scale-up. Physicians need training in shared decision making skills about goals of care and in using the decision aid. A video version of the decision aid could clarify its purpose.

PMID:
29447297
PMCID:
PMC5813934
DOI:
10.1371/journal.pone.0191844
[Indexed for MEDLINE]
Free PMC Article

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