Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Am J Hosp Palliat Care. 2023 Aug;40(8):881-893. doi: 10.1177/10499091221134030. Epub 2022 Oct 14.
Patient portals can be an innovative and efficient way to engage patients in advance care planning (ACP). However, comprehension and judgment in older adults with cognitive impairment presents several barriers and challenges to engaging in new technology. Our objective was to develop an ACP portal-based tool (ACPVoice) for community-dwelling persons living with cognitive impairment (PLCI) by engaging end-users in the design process. Two rounds of cognitive interviews were conducted to identify and resolve cognitive issues related to comprehension, judgment, response, and to assess content validity. Purposive sampling was used with the goal of enrolling 15 different participants (five with mild cognitive impairment and five dyads (those with mild dementia and their care partner) in round to assess respondents' understanding of questions related to advance care planning to be administered via the patient portal. Twenty PLCI (mean age 78.4, 10 females [50%]) and ten care partners (mean age 60.9, 9 females [90%]) completed cognitive interviews between May 2021 and October 2021. The mean Mini-Mental State Examination score for PLCI was 25.6 (SD 2.6). Unclear wording and undefined vague and/or unfamiliar terms were the major issues identified. Revisions to item wording, response options, and instructions were made to improve question comprehension and response as well as navigational ease. Minor changes to the wording, format, and response options substantially improved respondents' ability to interpret the item content of the ACPVoice tool. Dissemination and implementation of the ACPVoice tool could help to engage community-dwelling PLCI in ACP discussions.
患者门户可以成为一种创新且高效的方式，使患者参与到预先护理计划（ACP）中。然而，在认知障碍的老年患者中，理解和判断能力会给他们使用新技术带来诸多障碍和挑战。我们的目标是通过让终端用户参与设计过程，为居住在社区中患有认知障碍（PLCI）的患者开发一个基于 ACP 门户的工具（ACPVoice）。进行了两轮认知访谈，以识别和解决与理解、判断、回答相关的认知问题，并评估内容的有效性。采用了目的性抽样，目的是招募 15 名不同的参与者（5 名轻度认知障碍和 5 对（轻度痴呆症患者及其照顾者），以评估受访者对将通过患者门户管理的预先护理计划相关问题的理解。共有 20 名 PLCI（平均年龄 78.4 岁，女性 10 名[50%]）和 10 名照顾者（平均年龄 60.9 岁，女性 9 名[90%]）于 2021 年 5 月至 2021 年 10 月完成了认知访谈。PLCI 的平均简易精神状态检查评分是 25.6（标准差 2.6）。主要问题是表述不清楚和术语未定义，模糊且/或不熟悉。对项目表述、回答选项和说明进行了修订，以提高问题理解和回答以及导航的便利性。对措辞、格式和回答选项进行的微小更改极大地提高了受访者对 ACPVoice 工具项目内容的理解能力。ACPVoice 工具的传播和实施可以帮助居住在社区的 PLCI 参与 ACP 讨论。
