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Zeng A, Tang Q, O'Hagan E, McCaffery K, Ijaz K, Quiroz JC, Kocaballi AB, Rezazadegan D, Trivedi R, Siette J, Shaw T, Makeham M, Thiagalingam A, Chow CK, Laranjo L. Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysis. BMJ Evid Based Med 2024:bmjebm-2023-112820. [PMID: 38950915 DOI: 10.1136/bmjebm-2023-112820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF. STUDY DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF. INFORMATION SOURCES We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies. SYNTHESIS OF RESULTS We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge. RESULTS 13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference -0.19; 95% CI -0.30 to -0.08; p=0.001; I2=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI -19.5 to -5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery. CONCLUSIONS In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted. PROSPERO REGISTRATION NUMBER CRD42020218025.
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Affiliation(s)
- Aileen Zeng
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Queenie Tang
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, The University of Sydney, Sydney, New South Wales, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ahmet Baki Kocaballi
- School of Computer Science, Faculty of Engineering & Information Technology, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Dana Rezazadegan
- Department of Computing Technologies, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ritu Trivedi
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, New South Wales, Australia
| | - Timothy Shaw
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Makeham
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Liu J, Li JF, Li XX, Wu YP, Li SR, Li LY, Zhou HP. Awareness of Hospice Care Among Community-Dwelling Elderly Participants. Res Theory Nurs Pract 2023; 37:386-400. [PMID: 37591529 DOI: 10.1891/rtnp-2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Background and Purpose: The main goal of hospice care is to improve the quality of life for people who are at the end-of-life phase. However, investigations on the awareness of hospice care among community-dwelling elderly participants are limited. This work aimed to reveal the awareness status of hospice care and explore the factors influencing the awareness rate among elderly participants. Methods: A questionnaire survey was conducted among individuals aged 60 years and above. Results: A total of 4,969 individuals aged 60 years and above were randomly selected from 48 primary medical institutions in Handan. The awareness rate of hospice care in the baseline survey was 19.3% (n = 959). All included individuals were divided into two groups in accordance with their awareness of hospice care. The awareness of hospice care among participants with low educational level, living alone, and afraid of talking about death was low (p < .05). Implications for Practice: The level of awareness of hospice care among community-dwelling elderly participants is low. The influencing factors included educational level, living status, and fear of talking about death. The community-dwelling elderly participants' awareness of hospice care must be improved. It is recommended that public medical education and training should be enhanced to improve knowledge and awareness of hospice care among community-dwelling elderly residents with low educational level, living alone, and afraid of talking about death.
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Affiliation(s)
- Jun Liu
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Jun-Fang Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Xiao-Xiao Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Yi-Ping Wu
- Department of Neurology, Handan Central Hospital, Handan, China
| | - Shu-Rui Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Li-Yang Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Hai-Ping Zhou
- Department of Ageing and Health, Medical Association of Handan, Handan, China
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Feasibility and acceptability of a web-based advance care plan for dementia. Geriatr Nurs 2022; 44:251-258. [PMID: 35259603 PMCID: PMC9190025 DOI: 10.1016/j.gerinurse.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
While advance care planning (ACP) can help elicit preferences and is associated with improved end-of-life outcomes, persons living with dementia (PLWD) in nursing homes are rarely included in ACP. Web-based decision aids are a readily available tool to engage PLWD in ACP, but none are designed for the unique needs of PLWD, particularly those residing in nursing homes. Our Memory Care Wishes (OMCW) was adapted from a publicly available web-based ACP tool in collaboration with dementia care experts. This study aimed to explore the acceptability of OMCW. We used a convergent, mixed methods design to describe PLWD and surrogates' experiences using the OMCW website. Participants described ease of use, comfort with viewing, helpfulness for planning, and likelihood to recommend. Overall, OMCW is acceptable, however, PLWD continue to have difficulties understanding and engaging with some website content. Modifications were incorporated based on these findings, setting the stage for implementation and effectiveness testing.
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Lungu DA, Røislien J, Wiig S, Shortt MT, Ferrè F, Berg SH, Thune H, Brønnick KK. The Role of Recipient Characteristics in Health Video Communication Outcomes: Scoping Review. J Med Internet Res 2021; 23:e30962. [PMID: 34967758 PMCID: PMC8759013 DOI: 10.2196/30962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. OBJECTIVE The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? METHODS A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. RESULTS Of the 1040 documents initially identified, 128 (12.31%) met the criteria for full-text assessment, and 39 (3.75%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. CONCLUSIONS Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication.
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Affiliation(s)
- Daniel Adrian Lungu
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jo Røislien
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marie Therese Shortt
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Henriette Thune
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Evaluating the Balance Between Privacy and Access in Digital Information Sharing. Crit Care Med 2021; 50:e109-e116. [PMID: 34637416 PMCID: PMC8797001 DOI: 10.1097/ccm.0000000000005234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Access to personal health records in an ICU by persons involved in the patient’s care (referred to broadly as “family members” below) has the potential to increase engagement and reduce the negative psychologic sequelae of such hospitalizations. Currently, little is known about patient preferences for information sharing with a designated family member in the ICU. We sought to understand the information-sharing preferences of former ICU patients and their family members and to identify predictors of information-sharing preferences.
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Edwards JD, Panitch HB, George M, Cirrilla AM, Grunstein E, Wolfe J, Nelson JE, Miller RL. Development and validation of a novel informational booklet for pediatric long-term ventilation decision support. Pediatr Pulmonol 2021; 56:1198-1204. [PMID: 33305899 PMCID: PMC8035285 DOI: 10.1002/ppul.25221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To provide accessible, uniform, comprehensive, and balanced information to families deciding whether to initiate long-term ventilation (LTV) for their child, we sought to develop and validate a novel informational resource. METHODS The Ottawa Decision Support Framework was followed. Previous interviews with 44 lay and 15 professional stakeholders and published literature provided content for a booklet. Iterative versions were cognitive tested with six parents facing decisions and five pediatric intensivists. Ten parents facing decisions evaluated the booklet using the Preparation for Decision Making Scale and reported their decisional conflict, which was juxtaposed to the conflict of 21 parents who did not read it, using the Decisional Conflict Scale. Twelve home ventilation program directors evaluated the booklet's clinical sensibility and sensitivity, using a self-designed six-item questionnaire. Data presented using summary statistics. RESULTS The illustrated booklet (6th-grade reading level) has nine topical sections on chronic respiratory failure and invasive and noninvasive LTV, including the option to forgo LTV. Ten parents who read the booklet rated it as helping "Quite a bit" or more on all items of the Preparation for Decision Making Scale and had seemingly less decisional conflict than 21 parents who did not. Twelve directors rated it highly for clinical sensibility and sensitivity. CONCLUSIONS The LTV booklet was rigorously developed and favorably evaluated. It offers a resource to improve patient/family knowledge, supplement shared decision-making, and reduce decisional conflict around LTV decisions. Future studies should validate it in other settings and further study its effectiveness.
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Affiliation(s)
- Jeffrey D Edwards
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Valegos College of Physicians and Surgeons, New York, New York, USA
| | - Howard B Panitch
- Division of Pulmonary Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen George
- Columbia University School of Nursing, New York, New York, USA
| | - Anne-Marie Cirrilla
- Department of Care Coordination/Social Work, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Eli Grunstein
- Division of Pediatric Otolaryngology, Columbia University Valegos College of Physicians and Surgeons, New York, New York, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judith E Nelson
- Critical Care Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA.,Palliative Medicine Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Abstract
Background Evidence-based Clinical Decision Support Systems (CDSSs) usually obtain clinical evidences from randomized controlled trials based on coarse-grained groups. Individuals who are beyond the scope of the original trials cannot be accurately and objectively supported. Also, patients’ opinions and preferences towards the health care delivered to them have rarely been considered. In this regards, we propose to use clinical experience data as an evidence to support patient-oriented decision-making. Methods The experience data of similar patients from social networks as subjective evidence and the argumentation rules derived from clinical guidelines as objective evidence are combined to support decision making together. They are integrated into a comprehensive decision support architecture. The patient reviews are crawled from social networks and sentimentally analyzed to become structured data which are mapped to the Clinical Sentiment Ontology (CSO). This is used to build a Patient Experience Knowledge Base (PEKB) that can complement the original clinical guidelines. An Experience Inference Engine (EIE) is developed to match similar experience cases from both patient preference features and patient conditions and ultimately, comprehensive clinical recommendations are generated. Results A prototype system is designed and implemented to show the feasibility of the decision support architecture. The system allows patients and domain experts to easily explore various choices and trade-offs via modifying attribute values to select the most appropriate decisions. Conclusions The integrated decision support architecture built is generic to solving a wide range of clinical problems. This will lead to better-informed clinical decisions and ultimately improved patient care.
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Suen AO, Butler RA, Arnold R, Myers B, Witteman HO, Cox CE, Argenas A, Buddadhumaruk P, Bursic A, Ernecoff NC, Shields AM, Tran DK, White DB. Developing the family support tool: An interactive, web-based tool to help families navigate the complexities of surrogate decision making in ICUs. J Crit Care 2019; 56:132-139. [PMID: 31896447 DOI: 10.1016/j.jcrc.2019.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/24/2019] [Accepted: 12/05/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Although family members of incapacitated, critically ill patients often struggle in the role of surrogate decision maker, there are no low-cost, easily-scaled interventions to address this problem. AIM OF THE STUDY To develop and pilot-test the Family Support Tool, an interactive, web-based tool to help individuals navigate the complexities of surrogate decision making in ICUs. MATERIAL AND METHODS We used a mixed methods, user-centered process to create the Family Support Tool, including: 1) creation of a preliminary design by an expert panel; 2) engagement of a key stakeholder panel to iteratively refine the preliminary design; 3) user testing of a low-fidelity prototype of the tool by 6 former ICU surrogates; 4) creation of a web-based prototype; and 5) user testing of the web-based prototype with 14 surrogates and ICU physicians, including semi-structured interviews and quantitative measurement of usability, acceptability, and perceived effectiveness. RESULTS The initial design contained a collection of videos and exercises designed to help individuals understand the surrogate's role and think through the patient's values and preferences. Based on family stakeholders' feedback about the emotional overwhelm they experience early in an ICU stay, we redesigned the tool to be viewed in sections, with the first section focused on decreasing surrogates' emotional distress, and later sections focused on helping surrogates prepare for family meetings. Surrogates actively making decisions in the ICU judged the final tool to be highly usable (mean summary score 83.5, correlating to 95th percentile when normalized to devices of its type), acceptable (mean 4.2 +/- 0.5 out of 5), and effective (mean 4.3 +/- 0.6 out of 5). All surrogates reported the tool helped them consider goals of care and all indicated they would recommend the tool to a friend. CONCLUSIONS We successfully developed a web-based tool to help individuals navigate the complexities of surrogate decision making in ICUs that has high potential for scalability. Surrogates judged the tool to be usable, acceptable, and effective. These data support proceeding to test the tool in a pilot randomized clinical trial.
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Affiliation(s)
- Angela O Suen
- University of Pittsburgh, School of Medicine, Department of Medicine, Division of General Internal Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States of America
| | - Rachel A Butler
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Robert Arnold
- University of Pittsburgh, School of Medicine, Department of Medicine, Division of General Internal Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States of America; University of Pittsburgh Medical Center Palliative and Supportive Institute, Iroquois Building, Suite 308, 3600 Forbes Avenue at Meyran Avenue, Pittsburgh, PA 15213, United States of America
| | - Brad Myers
- Carnegie Mellon University, School of Computer Science, Human Computer Interaction Institute, 5000 Forbes Avenue, Pittsburgh, PA 15213, United States of America
| | - Holly O Witteman
- Université Laval, Department of Family & Emergency Medicine, Bureau 4617, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6, Canada
| | - Christopher E Cox
- Duke University, School of Medicine, Department of Medicine, Division of Pulmonary & Critical Care Medicine, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Amanda Argenas
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Praewpannanrai Buddadhumaruk
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Alexandra Bursic
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Natalie C Ernecoff
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Anne-Marie Shields
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Dang K Tran
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America
| | - Douglas B White
- University of Pittsburgh, School of Medicine, Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Program on Ethics and Decision Making, 600 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, United States of America.
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Patients Decision Aid System Based on FHIR Profiles. J Med Syst 2018; 42:166. [PMID: 30066031 DOI: 10.1007/s10916-018-1016-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
Patients are becoming more and more involved in clinical decision-making process. Several factors support this process. Advances in omics allows individualization of diagnosis and treatment. Patient awareness and easy availability of data on the Internet allows patients to become informed decision makers when it comes even to disease management. Mass media emphasize the issue of medical errors, making patients demanding for quality in medical care. In some healthcare settings, patents face a problem of interpreting medical data and making decisions on treatment tactics without having a doctor, who could potentially support them. Delegating this task to a Patient Decision Aide system can add automatically generated recommendations to result reports without adding significant workload on the doctors, increase patients' motivation and support their decisions. We have implemented a patient decision aid system based on the productions rules, which: Collects data from available sources; Automatically analyses and interprets laboratory test results; Recommends running additional tests for a more precise diagnostic; Delivers automatically generated reports to doctors and patients in a natural language. To achieve semantic interoperability with other systems we have implemented a FHIR engine. The knowledge base has been organized as a graph structure. The application is structured as a set of lightly coupled services, which implement the logic of the decision support system. In total, we have modelled 365 nodes of test components, 5084 nodes of inference rules, 49932 connections and 3072 blocks of text for medical certificates. The findings of the research provide a deep understanding of how the semantically interoperable clinical decision support systems are implemented. Advances in notification the patients with the elements of patient decision aid is important for clinical data management, and for patients' empowerment and protection. We suppose that the system empowering patients in such way can play a meaningful role in helping patients to make informed decisions during the process of diagnostics and treatment.
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Zahuranec DB, Anspach RR, Roney ME, Fuhrel-Forbis A, Connochie DM, Chen EP, Thompson BB, Varelas PN, Morgenstern LB, Fagerlin A. Surrogate Decision Makers' Perspectives on Family Members' Prognosis after Intracerebral Hemorrhage. J Palliat Med 2018; 21:956-962. [PMID: 29608394 DOI: 10.1089/jpm.2017.0604] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surrogate communication with providers about prognosis in the setting of acute critical illness can impact both patient treatment decisions and surrogate outcomes. OBJECTIVES To examine surrogate decision maker perspectives on provider prognostic communication after intracerebral hemorrhage (ICH). DESIGN Semistructured interviews were conducted and analyzed qualitatively for key themes. SETTING/SUBJECTS Surrogate decision makers for individuals admitted with ICH were enrolled from five acute care hospitals. RESULTS Fifty-two surrogates participated (mean age = 54, 60% women, 58% non-Hispanic white, 13% African American, 21% Hispanic). Patient status at interview was hospitalized (17%), in rehabilitation/nursing facility (37%), deceased (38%), hospice (4%), or home (6%). Nineteen percent of surrogates reported receiving discordant prognoses, leading to distress or frustration in eight cases (15%) and a change in decision for potentially life-saving brain surgery in three cases (6%). Surrogates were surprised or confused by providers' use of varied terminology for the diagnosis (17%) (e.g., "stroke" vs. "brain hemorrhage" or "brain bleed") and some interpreted "stroke" as having a more negative connotation. Surrogates reported that physicians expressed uncertainty in prognosis in 37%; with physician certainty in 56%. Surrogate reactions to uncertainty were mixed, with some surrogates expressing a negative emotional response (e.g., anxiety) and others reporting understanding or acceptance of uncertainty. CONCLUSIONS Current practice of prognostic communication in acute critical illness has many gaps, leading to distress for surrogates and variability in critical treatment decisions. Further work is needed to limit surrogate distress and improve the quality of treatment decisions.
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Affiliation(s)
- Darin B Zahuranec
- 1 Stroke Program, Department of Neurology, Michigan Medicine , Ann Arbor, Michigan.,2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan
| | - Renee R Anspach
- 3 Department of Sociology, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Meghan E Roney
- 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan
| | - Andrea Fuhrel-Forbis
- 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan
| | - Daniel M Connochie
- 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan
| | - Emily P Chen
- 1 Stroke Program, Department of Neurology, Michigan Medicine , Ann Arbor, Michigan.,2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan
| | - Bradford B Thompson
- 4 Department of Neurology, Alpert Medical School at Brown University , Providence, Rhode Island.,5 Department of Neurosurgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Panayiotis N Varelas
- 6 Department of Neurology and Neurosurgery, Henry Ford Hospital , Detroit, Michigan
| | - Lewis B Morgenstern
- 1 Stroke Program, Department of Neurology, Michigan Medicine , Ann Arbor, Michigan.,7 Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan.,8 Department of Emergency Medicine, Michigan Medicine , Ann Arbor, Michigan
| | - Angela Fagerlin
- 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan.,9 Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City, Utah.,10 Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS) , Salt Lake City, Utah
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Moskowitz J, Quinn T, Khan MW, Shutter L, Goldberg R, Col N, Mazor KM, Muehlschlegel S. Should We Use the IMPACT-Model for the Outcome Prognostication of TBI Patients? A Qualitative Study Assessing Physicians' Perceptions. MDM Policy Pract 2018; 3:2381468318757987. [PMID: 30288437 PMCID: PMC6124938 DOI: 10.1177/2381468318757987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/26/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction. Shared Decision-Making may facilitate information exchange, deliberation, and effective decision-making, but no decision aids currently exist for difficult decisions in neurocritical care patients. The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids (DA), recommends the presentation of numeric outcome and risk estimates. Efforts are underway to create a goals-of-care DA in critically-ill traumatic brain injury (ciTBI) patients. To inform its content, we examined physicians’ perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored physicians’ preferences for communicating prognostic information towards families. Methods. We conducted a qualitative study using semi-structured interviews in 20 attending physicians (neurosurgery,neurocritical care,trauma,palliative care) at 7 U.S. academic medical centers. We used performed qualitative content analysis of transcribed interviews to identify major themes. Results. Only 12 physicians (60%) expressed awareness of the IMPACT-model; two stated that they “barely” knew the model. Seven physicians indicated using the model at least some of the time in clinical practice, although none used it exclusively to derive a patient’s prognosis. Four major themes emerged: the IMPACT-model is intended for research but should not be applied to individual patients; mistrust in the IMPACT-model derivation data; the IMPACT-model is helpful in reducing prognostic variability among physicians; concern that statistical models may mislead families about a patient’s prognosis. Discussion: Our study identified significant variability of the awareness, perception, and use of the IMPACT-model among physicians. While many physicians prefer to avoid conveying numeric prognostic estimates with families using the IMPACT-model, several physicians thought that they “ground” them and reduce prognostic variability among physicians. These findings may factor into the creation and implementation of future ciTBI-related DAs.
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Affiliation(s)
- Jesse Moskowitz
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Thomas Quinn
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Muhammad W Khan
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Lori Shutter
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Robert Goldberg
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Nananda Col
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Kathleen M Mazor
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Susanne Muehlschlegel
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
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12
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Recognizing difficult trade-offs: values and treatment preferences for end-of-life care in a multi-site survey of adult patients in family practices. BMC Med Inform Decis Mak 2017; 17:164. [PMID: 29212487 PMCID: PMC5719577 DOI: 10.1186/s12911-017-0570-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decisions about care options and the use of life-sustaining treatments should be informed by a person's values and treatment preferences. The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient's expressed treatment preference. METHODS We conducted a multi-site survey in 20 family practices. Patients aged 50 and older self-completed a questionnaire assessing the importance of eight values (rated 1 to 10), and indicated their preference for use of life-sustaining treatment (5 options). We compared correlations among values to a priori hypotheses based on whether the value related to prolonging or shortening life, and examined expected relationships between importance of values and the preference option for life-sustaining treatment. RESULTS Eight hundred ten patients participated (92% response rate). Of 24 a priori predicted correlations among values statements, 14 were statistically significant but nearly all were negligible in their magnitude and some were in the opposite direction than expected. For example, the correlation between importance of being comfortable and suffering as little as possible and the importance of living as long as possible should have been inversely correlated but was positively correlated (r = 0.08, p = 0.03). Correlations between importance of values items and preference were negligible, ranging from 0.03 to 0.13. CONCLUSIONS Patients may not recognize that trade-offs in what is most important may be needed when considering the use of treatments. In the context of preparation for decision-making during serious illness, decision aids that highlight these trade-offs and connect values to preferences more directly may be more helpful than those that do not.
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13
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Frivold G, Slettebø Å, Heyland DK, Dale B. Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study. Nurs Open 2017; 5:6-14. [PMID: 29344389 PMCID: PMC5762765 DOI: 10.1002/nop2.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death. Design A cross‐sectional survey study was conducted. Methods Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS‐ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis. Results A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.
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Affiliation(s)
- Gro Frivold
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Åshild Slettebø
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Daren K Heyland
- Clinical Evaluation Research Unit Kingston General Hospital Kingston ON Canada.,The Canadian Researchers at the End of Life Network Kingston ON Canada.,Critical Care Nutrition Department of Critical Care Medicine Queen's University Kingston ON Canada
| | - Bjørg Dale
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway.,Centre for Caring Research Southern Norway Grimstad Norway
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14
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Quaglini S, Sacchi L, Lanzola G, Viani N. Personalization and Patient Involvement in Decision Support Systems: Current Trends. Yearb Med Inform 2017; 10:106-18. [PMID: 26293857 DOI: 10.15265/iy-2015-015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. METHODS We considered papers published on scientific journals, by querying PubMed and Web of ScienceTM. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. RESULTS We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. CONCLUSIONS Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large.
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Affiliation(s)
- S Quaglini
- Silvana Quaglini, Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy, Tel: +39 0382 985058, Fax: +39 0382 985060, E-mail:
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15
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Combining patient preferences with expected treatment outcomes to inform decision-making. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2017. [DOI: 10.1007/s10742-016-0166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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The unmet need of information access for family members of ICU patients. Intensive Care Med 2016; 43:240-242. [PMID: 28011990 DOI: 10.1007/s00134-016-4656-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/16/2016] [Indexed: 01/24/2023]
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17
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Brown SM, Aboumatar HJ, Francis L, Halamka J, Rozenblum R, Rubin E, Sarnoff Lee B, Sugarman J, Turner K, Vorwaller M, Frosch DL. Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit. J Am Med Inform Assoc 2016; 23:995-1000. [PMID: 26984048 DOI: 10.1093/jamia/ocv182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information. Approaches to identifying the optimal balance between access to digital health information to facilitate engagement and protecting patient privacy are urgently needed. We identified eight themes that should be considered in balancing health information access and patient privacy: 1) potential benefits to patients from PDM data access; 2) potential harms to patients from such access; 3) the moral status of families within the patient-clinician relationship; 4) the scope of relevant information provided to PDMs; 5) issues around defining PDMs' authority; 6) methods for eliciting and documenting patient preferences about their family's information access; 7) the relevance of methods for ascertaining the identity of PDMs; and 8) the obligations of hospitals to prevent privacy breaches by PDMs. We conclude that PDMs should typically have access to health information from the current episode of care when the patient is decisionally impaired, unless the patient has previously expressed a clear preference that PDMs not have such access.
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Affiliation(s)
- Samuel M Brown
- Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S. Cottonwood St, Murray, UT USA and Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hanan J Aboumatar
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leslie Francis
- University of Utah S.J. Quinney College of Law, Salt Lake City, UT, USA
| | - John Halamka
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ronen Rozenblum
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD USA Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD USA Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen Turner
- San Francisco Medical Center, University of California, San Francisco, CA, USA
| | - Micah Vorwaller
- University of Utah S.J. Quinney College of Law, Salt Lake City, UT, USA
| | - Dominick L Frosch
- Gordon and Betty Moore Foundation, San Francisco, CA, USA and Department of Medicine, University of California, Los Angeles, CA, USA
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18
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Ernecoff NC, Witteman HO, Chon K, Chen YI, Buddadhumaruk P, Chiarchiaro J, Shotsberger KJ, Shields AM, Myers BA, Hough CL, Carson SS, Lo B, Matthay MA, Anderson WG, Peterson MW, Steingrub JS, Arnold RM, White DB. Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs. J Crit Care 2016; 33:19-25. [PMID: 27037049 DOI: 10.1016/j.jcrc.2016.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Natalie C Ernecoff
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Holly O Witteman
- 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
| | - Kristen Chon
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yanquan Iris Chen
- Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA
| | - Praewpannarai Buddadhumaruk
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jared Chiarchiaro
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Anne-Marie Shields
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brad A Myers
- Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA
| | - Shannon S Carson
- Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA
| | - Wendy G Anderson
- Department of Medicine and Division of Hosiptal Medicine and Palliative Care Program, University of California San Francisco, San Francisco, CA
| | - Michael W Peterson
- Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA
| | - Jay S Steingrub
- Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, MA
| | - Robert M Arnold
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Douglas B White
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Goligher EC, Douflé G, Fan E. Update in Mechanical Ventilation, Sedation, and Outcomes 2014. Am J Respir Crit Care Med 2015; 191:1367-73. [DOI: 10.1164/rccm.201502-0346up] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Brown SM, Rozenblum R, Aboumatar H, Fagan MB, Milic M, Lee BS, Turner K, Frosch DL. Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med 2015; 191:358-60. [PMID: 25635496 DOI: 10.1164/rccm.201410-1936le] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samuel M Brown
- 1 Intermountain Medical Center Murray, Utah University of Utah Salt Lake City, Utah and
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21
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Cox CE, Wysham NG, Walton B, Jones D, Cass B, Tobin M, Jonsson M, Kahn JM, White DB, Hough CL, Lewis CL, Carson SS. Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation. Ann Intensive Care 2015; 5:6. [PMID: 25852965 PMCID: PMC4385299 DOI: 10.1186/s13613-015-0045-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/19/2015] [Indexed: 01/29/2023] Open
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. Electronic supplementary material The online version of this article (doi:10.1186/s13613-015-0045-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher E Cox
- 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
| | - Nicholas G Wysham
- 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 ; Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC USA
| | - Brenda Walton
- 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
| | - Derek Jones
- 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
| | - Brian Cass
- Information Technologist, Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Maria Tobin
- Information Technologist, Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Mattias Jonsson
- Information Technologist, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Catherine L Hough
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA USA
| | - Carmen L Lewis
- Department of Medicine, Division of General Internal Medicine, University of Colorado, Denver, CO USA
| | - Shannon S Carson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Chapman AR, Litton E, Chamberlain J, Ho KM. The effect of prognostic data presentation format on perceived risk among surrogate decision makers of critically ill patients: a randomized comparative trial. J Crit Care 2014; 30:231-5. [PMID: 25480457 DOI: 10.1016/j.jcrc.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/23/2014] [Accepted: 11/07/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study is to determine whether varying the format used to present prognostic data alters the perception of risk among surrogate decision makers in the intensive care unit (ICU). METHODS This was a prospective randomized comparative trial conducted in a 23-bed adult tertiary ICU. Enrolled surrogate decision makers were randomized to 1 of 2 questionnaires, which presented hypothetical ICU scenarios, identical other than the format in which prognostic data were presented (eg, frequencies vs percentages). Participants were asked to rate the risk associated with each prognostic statement. RESULTS We enrolled 141 surrogate decision makers. The perception of risk varied significantly dependent on the presentation format. For "quantitative data," risks were consistently perceived as higher, when presented as frequencies (eg, 1 in 50) compared with equivalent percentages (eg, 2%). Framing "qualitative data" in terms of chance of "death" rather than "survival" led to a statistically significant increase in perceived risks. Framing "quantitative" data in this way did not significantly affect risk perception. CONCLUSION Data format had a significant effect on how surrogate decision makers interpreted risk. Qualitative statements are interpreted widely and affected by framing. Where possible, multiple quantitative formats should be used for presenting prognostic information.
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Affiliation(s)
- Andy R Chapman
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia.
| | - Edward Litton
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia
| | - Jenny Chamberlain
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia
| | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia; School of Population Health, University of Western Australia, Perth, Western Australia
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