Cox Christopher E, Wysham Nicholas G, Walton Brenda, Jones Derek, Cass Brian, Tobin Maria, Jonsson Mattias, Kahn Jeremy M, White Douglas B, Hough Catherine L, Lewis Carmen L, Carson Shannon S
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.
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.
Ann Intensive Care. 2015 Mar 25;5:6. doi: 10.1186/s13613-015-0045-0. eCollection 2015.
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.
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.
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.
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.
基于网络的决策辅助工具在医学研究和临床护理中日益重要。然而，在重症监护病房环境中对其进行研究的却很少。本研究的目的是为接受长期机械通气患者的家属开发一种基于网络的决策辅助工具，并评估其可用性和可接受性。
我们采用迭代过程，邀请了48名危重病幸存者、家属代理决策者和重症监护医生参与，开发了一种基于网络的决策辅助工具，该工具针对长期机械通气患者的代理决策者的护理偏好目标，既可以由研究人员管理，也可以由家属独立完成（开发阶段）。在13名代理决策者和7名重症监护医生中试用该决策辅助工具后，我们在评估阶段使用系统可用性量表（SUS）对30名代理决策者组成的队列评估了该决策辅助工具的可用性。使用满意度测量以及对电子协作决策支持（eCODES）与原始纸质决策辅助工具的偏好来评估可接受性。
最终的决策辅助工具称为“电子协作决策支持”，它提供了一个共享决策的框架，引出相关的价值观和偏好，纳入临床数据以个性化由ProVent预测模型生成的预后估计，生成一份可打印文档，总结用户与决策辅助工具的交互过程，并且可以对每个用户会话进行数字存档。总体而言，可用性非常好（平均SUS为80±10），但56岁及以上人群（73±7）的可用性低于较年轻人群（84±9）；p = 0.03。共有93%的用户表示更喜欢电子版而非纸质版。
针对重症监护病房代理决策者的基于网络的决策辅助工具可以促进高度个性化的信息共享，具有出色的可用性和可接受性。采用电子格式（如eCODES）的决策辅助工具是一种可以加强重症监护中患者 - 临床医生协作和决策质量的策略。
