Schapira Marilyn M, Chhatre Sumedha, Prigge Jason M, Meline Jessica, Kaminstein Dana, Rodriguez Keri L, Fraenkel Liana, Kravetz Jeffrey D, Whittle Jeff, Bastian Lori A, Vachani Anil, Akers Scott, Schrand Susan, Ibarra Jennifer V, Asan Onur
Center for Health Equity Research and Promotion, Michael J Crescenz VA Medical Center, Philadelphia, PA, United States.
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
JMIR Form Res. 2022 Apr 8;6(4):e29039. doi: 10.2196/29039.
Web-based tools developed to facilitate a shared decision-making (SDM) process may facilitate the implementation of lung cancer screening (LCS), an evidence-based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that affect the benefits and potential harms of LCS and thus may value a veteran-centric LCS decision tool (LCSDecTool).
This study aims to conduct usability testing of an LCSDecTool designed for veterans receiving care at a Veteran Affairs medical center.
Usability testing of the LCSDecTool was conducted in a prototype version (phase 1) and a high-fidelity version (phase 2). A total of 18 veterans and 8 clinicians participated in phase 1, and 43 veterans participated in phase 2. Quantitative outcomes from the users included the System Usability Scale (SUS) and the End User Computing Satisfaction (EUCS) in phase 1 and the SUS, EUCS, and Patient Engagement scale in phase 2. Qualitative data were obtained from observations of user sessions and brief interviews. The results of phase 1 informed the modifications of the prototype for the high-fidelity version. Phase 2 usability testing took place in the context of a pilot hybrid type 1 effectiveness-implementation trial.
In the phase 1 prototype usability testing, the mean SUS score (potential range: 0-100) was 81.90 (SD 9.80), corresponding to an excellent level of usability. The mean EUCS score (potential range: 1-5) was 4.30 (SD 0.71). In the phase 2 high-fidelity usability testing, the mean SUS score was 65.76 (SD 15.23), corresponding to a good level of usability. The mean EUCS score was 3.91 (SD 0.95); and the mean Patient Engagement scale score (potential range 1 [low] to 5 [high]) was 4.62 (SD 0.67). The median time to completion in minutes was 13 (IQR 10-16). A thematic analysis of user statements documented during phase 2 high-fidelity usability testing identified the following themes: a low baseline level of awareness and knowledge about LCS increased after use of the LCSDecTool; users sought more detailed descriptions about the LCS process; the LCSDecTool was generally easy to use, but specific navigation challenges remained; some users noted difficulty understanding medical terms used in the LCSDecTool; and use of the tool evoked veterans' struggles with prior attempts at smoking cessation.
Our findings support the development and use of this eHealth technology in the primary care clinical setting as a way to engage veterans, inform them about a new cancer control screening test, and prepare them to participate in an SDM discussion with their provider.
为促进共同决策（SDM）过程而开发的基于网络的工具，可能有助于实施肺癌筛查（LCS），这是一项旨在改善癌症治疗效果的循证干预措施。退伍军人有特定的风险因素和共同经历，这些会影响LCS的益处和潜在危害，因此可能会重视以退伍军人为中心的LCS决策工具（LCSDecTool）。
本研究旨在对为在退伍军人事务医疗中心接受治疗的退伍军人设计的LCSDecTool进行可用性测试。
对LCSDecTool的可用性测试分原型版本（第1阶段）和高保真版本（第2阶段）进行。共有18名退伍军人和8名临床医生参与了第1阶段，43名退伍军人参与了第2阶段。用户的定量结果包括第1阶段的系统可用性量表（SUS）和最终用户计算满意度（EUCS），以及第2阶段的SUS、EUCS和患者参与度量表。定性数据来自对用户会话的观察和简短访谈。第1阶段的结果为高保真版本原型的修改提供了依据。第2阶段的可用性测试是在一项试点混合1型有效性-实施试验的背景下进行的。
在第1阶段的原型可用性测试中，SUS平均得分（潜在范围：0-100）为81.90（标准差9.80），对应于优秀的可用性水平。EUCS平均得分（潜在范围：1-5）为4.30（标准差0.71）。在第2阶段的高保真可用性测试中，SUS平均得分是65.76（标准差15.23），对应于良好的可用性水平。EUCS平均得分是3.91（标准差0.95）；患者参与度量表平均得分（潜在范围1[低]至5[高]）为4.62（标准差0.67）。完成的中位时间为13分钟（四分位距10-16）。对第2阶段高保真可用性测试期间记录的用户陈述进行的主题分析确定了以下主题：使用LCSDecTool后，对LCS的认识和知识的基线水平较低有所提高；用户寻求对LCS过程更详细的描述；LCSDecTool总体上易于使用，但仍存在特定的导航挑战；一些用户指出难以理解LCSDecTool中使用的医学术语；该工具的使用引发了退伍军人之前戒烟尝试的挣扎。
我们的研究结果支持在初级保健临床环境中开发和使用这种电子健康技术，作为一种让退伍军人参与进来、告知他们一项新的癌症控制筛查测试，并让他们准备好与提供者进行SDM讨论的方式。
