Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation
Open accessAbstract
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.
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The decision aid had rigorous development and high usability across all age groups.
“the decision aid’s rigorous development and high usability across all age groups (50)”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [50]
The Methods describe iterative development with 48 participants, followed by piloting and usability testing. The Results report excellent usability overall (mean SUS 80), but not high usability across every age group: participants aged 66 and older averaged 67, below the Methods’ target of >70 for good usability. (LLM, conf=0.88)
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Cites
Shared decision making — The pinnacle of patient-centered care
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A communication strategy and brochure for relatives of patients dying in the ICU.
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“This role has been associated with significant conflict and personal distress, including a high incidence of PTSD-like symptoms [18].”
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Research works printed but not linked: 13
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Cox, C. E., White, D. B., Hough, C. L., Jones, D. M., Kahn, J. M., Olsen, M. K., Lewis, C. L., Hanson, L. C., & Carson, S. S. (2019) · Annals of Internal Medicine · doi:10.7326/m18-2335 · Cited by 152 · see citing works
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Lichtenthal, W. G., Viola, M., Rogers, M., Roberts, K. E., Lief, L., Cox, C. E., Brewin, C. R., Xu, J. C., Maciejewski, P. K., Pan, C. X., et al. (2022) · Palliative and Supportive Care · doi:10.1017/s1478951521000626 · Cited by 23 · see citing works
“It invites an imaginal dialogue with the patient to garner the patient’s support in the surrogate’s struggle to consider the patient’s wishes and values, and to facilitate quality decisionmaking and empowerment (Tunzi, 2012; Cox et al., 2015).”
- Authors
- Cox, C. E., Wysham, N. G., Walton, B., Jones, D., Cass, B., Tobin, M., Jonsson, M., Kahn, J. M., White, D. B., Hough, C. L., Lewis, C. L., & Carson, S. S.
- Affiliations
- Duke University (US)
- University of North Carolina at Chapel Hill (US)
- University of Pittsburgh (US)
- University of Washington (US)
- University of Colorado Denver (US)
- Corresponding author
- Cox, Christopher E.
- ORCID
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2015
- Volume
- 5
- Issue
- 1
- Pages
- 6
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC4385299
- OpenAlex
- W2145517699
- Cited by
- 44
- References
- 3
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 5 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 7 · 2014: 1
- FWCI
- 5.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
- UNC Libraries
- Funders
- National Heart, Lung, and Blood Institute (R01HL109823)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- web-based decision aid, prolonged mechanical ventilation, surrogate decision-making, family caregivers, goals of care, shared decision-making, electronic decision support, usability, acceptability, intensive care unit, patient-clinician communication
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