Development of a Decision Aid for Cardiopulmonary Resuscitation Involving Intensive Care Unit Patients' and Health Professionals' Participation Using User-Centered Design and a Wiki Platform for Rapid Prototyping: A Research Protocol

Ariane Plaisance, Holly O Witteman, Daren Keith Heyland, Mark H Ebell, Audrey Dupuis, Carole-Anne Lavoie-Bérard, France Légaré, Patrick Michel Archambault, Ariane Plaisance, Holly O Witteman, Daren Keith Heyland, Mark H Ebell, Audrey Dupuis, Carole-Anne Lavoie-Bérard, France Légaré, Patrick Michel Archambault

Abstract

Background: Cardiopulmonary resuscitation (CPR) is an intervention used in cases of cardiac arrest to revive patients whose heart has stopped. Because cardiac arrest can have potentially devastating outcomes such as severe neurological deficits even if CPR is performed, patients must be involved in determining in advance if they want CPR in the case of an unexpected arrest. Shared decision making (SDM) facilitates discussions about goals of care regarding CPR in intensive care units (ICUs). Patient decision aids (DAs) are proven to support the implementation of SDM. Many patient DAs about CPR exist, but they are not universally implemented in ICUs in part due to lack of context and cultural adaptation. Adaptation to local context is an important phase of implementing any type of knowledge tool such as patient DAs. User-centered design supported by a wiki platform to perform rapid prototyping has previously been successful in creating knowledge tools adapted to the needs of patients and health professionals (eg, asthma action plans). This project aims to explore how user-centered design and a wiki platform can support the adaptation of an existing DA for CPR to the local context.

Objective: The primary objective is to use an existing DA about CPR to create a wiki-based DA that is adapted to the context of a single ICU and tailorable to individual patient's risk factors while employing user-centered design. The secondary objective is to document the use of a wiki platform for the adaptation of patient DAs.

Methods: This study will be conducted in a mixed surgical and medical ICU at Hôtel-Dieu de Lévis, Quebec, Canada. We plan to involve all 5 intensivists and recruit at least 20 alert and oriented patients admitted to the ICU and their family members if available. In the first phase of this study, we will observe 3 weeks of daily interactions between patients, families, intensivists, and other allied health professionals. We will specifically observe 5 dyads of attending intensivists and alert and oriented patients discussing goals of care concerning CPR to understand how a patient DA could support this decision. We will also conduct individual interviews with the 5 intensivists to identify their needs concerning the implementation of a DA. In the second phase of the study, we will build a first prototype based on the needs identified in Phase I. We will start by translating an existing DA entitled "Cardiopulmonary resuscitation: a decision aid for patients and their families." We will then adapt this tool to the needs we identified in Phase I and archive this first prototype in a wiki. Building on the wiki's programming architecture, we intend to integrate the Good Outcome Following Attempted Resuscitation risk calculator into our DA to determine personal risks and benefits of CPR for each patient. We will then present the first prototype to 5 new patient-intensivist dyads. Feedback about content and visual presentation will be collected from the intensivists through short interviews while longer interviews will be conducted with patients and their family members to inform the visual design and content of the next prototype. After each rapid prototyping cycle, 2 researchers will perform qualitative content analysis of data collected through interviews and direct observations. We will attempt to solve all content and visual design issues identified before moving to the next round of prototyping. In all, we will conduct 3 prototyping cycles with a total of 15 patient-intensivist dyads.

Results: We expect to develop a multimedia wiki-based DA to support goals of care discussions about CPR adapted to the local needs of patients, their family members, and intensivists and tailorable to individual patient risk factors. The final version of the DA as well as the development process will be housed in an open-access wiki and free to be adapted and used in other contexts.

Conclusions: This study will shed new light on the development of DAs adapted to local context and tailorable to individual patient risk factors employing user-centered design and a wiki to support rapid prototyping of content and visual design issues.

Keywords: cardiopulmonary resuscitation; end-of-life planning; goals of care discussions; intensive care medicine; medical informatics; shared decision making; user-centered design; wikis.

Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. The Conference Board of Canada How Canada Performs, Life Expectancy 2015. 2012. Feb, [2016-01-20]. .
    1. Fowler R, Hammer M. End-of-life care in Canada. Clin Invest Med. 2013;36(3):E127–32.
    1. Roch A, Wiramus S, Pauly V, Forel J, Guervilly C, Gainnier M, Papazian L. Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care. 2011;15(1):R36. doi: 10.1186/cc9984.
    1. Ebell MH, Jang W, Shen Y, Geocadin RG, Get With the Guidelines–Resuscitation Investigators Development and validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. JAMA Intern Med. 2013 Nov 11;173(20):1872–8. doi: 10.1001/jamainternmed.2013.10037.
    1. Frank C, Pichora D, Suurdt J, Heyland D. Development and use of a decision aid for communication with hospitalized patients about cardiopulmonary resuscitation preference. Patient Educ Couns. 2010 Apr;79(1):130–3. doi: 10.1016/j.pec.2009.08.002.
    1. Kryworuchko J, Hill E, Murray MA, Stacey D, Fergusson DA. Interventions for shared decision-making about life support in the intensive care unit: a systematic review. Worldviews Evid Based Nurs. 2013 Feb;10(1):3–16. doi: 10.1111/j.1741-6787.2012.00247.x.
    1. Légaré France, Stacey D, Turcotte S, Cossi M, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014;9:CD006732. doi: 10.1002/14651858.CD006732.pub3.
    1. Searl MM, Borgi L, Chemali Z. It is time to talk about people: a human-centered healthcare system. Health Res Policy Syst. 2010;8:35. doi: 10.1186/1478-4505-8-35.
    1. Straus S, Tetroe J, Graham I. Knowledge translation in health care moving from evidence to practice. Chichester, West Sussex: Wiley BMJI Books; 2013.
    1. Greenhalgh T, Howick J, Maskrey N, Evidence Based Medicine Renaissance Group Evidence based medicine: A movement in crisis? BMJ. 2014;348:g3725.
    1. Gagliardi AR, Alhabib S, members of Guidelines International Network Implementation Working Group Trends in guideline implementation: a scoping systematic review. Implement Sci. 2015;10:54. doi: 10.1186/s13012-015-0247-8.
    1. Gagliardi AR, Brouwers MC, Bhattacharyya OK. The development of guideline implementation tools: a qualitative study. CMAJ Open. 2015;3(1):E127–33. doi: 10.9778/cmajo.20140064.
    1. Pronovost PJ. Enhancing physicians' use of clinical guidelines. JAMA. 2013 Dec 18;310(23):2501–2. doi: 10.1001/jama.2013.281334.
    1. McKillop A, Crisp J, Walsh K. Practice guidelines need to address the 'how' and the 'what' of implementation. Prim Health Care Res Dev. 2012 Jan;13(1):48–59. doi: 10.1017/S1463423611000405.
    1. Dobbins M, Hanna SE, Ciliska D, Manske S, Cameron R, Mercer SL, O'Mara L, DeCorby K, Robeson P. A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies. Implement Sci. 2009;4:61. doi: 10.1186/1748-5908-4-61.
    1. Shekelle PG, Kravitz RL, Beart J, Marger M, Wang M, Lee M. Are nonspecific practice guidelines potentially harmful? A randomized comparison of the effect of nonspecific versus specific guidelines on physician decision making. Health Serv Res. 2000 Mar;34(7):1429–48.
    1. Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care. 1994 Mar;32(3):202–13.
    1. Archambault PM, van de Belt Tom H. Grajales FJ, Faber MJ, Kuziemsky CE, Gagnon S, Bilodeau A, Rioux S, Nelen Willianne L D M. Gagnon M, Turgeon AF, Aubin K, Gold I, Poitras J, Eysenbach G, Kremer Jan A M. Légaré France. Wikis and collaborative writing applications in health care: a scoping review. J Med Internet Res. 2013;15(10):e210. doi: 10.2196/jmir.2787.
    1. McLean R, Richards BH, Wardman JI. The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Med J Aust. 2007 Aug 6;187(3):174–7.
    1. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res. 2008;10(3):e22. doi: 10.2196/jmir.1030.
    1. Archambault PM. WikiBuild: a new application to support patient and health care professional involvement in the development of patient support tools. J Med Internet Res. 2011;13(4):e114. doi: 10.2196/jmir.1961.
    1. Archambault PM, Gagnon S, Gagnon M, Turcotte S, Lapointe J, Fleet R, Côté Mario, Beaupré Pierre, Le SN, Emond M, Légaré France. Development and validation of questionnaires exploring health care professionals' intention to use wiki-based reminders to promote best practices in trauma. JMIR Res Protoc. 2014;3(3):e50. doi: 10.2196/resprot.3762.
    1. Archambault PM, van de Belt Tom H. Grajales Iii Francisco J. Eysenbach G, Aubin K, Gold I, Gagnon M, Kuziemsky CE, Turgeon AF, Poitras J, Faber MJ, Kremer Jan A M. Heldoorn M, Bilodeau A, Légaré France. Wikis and collaborative writing applications in health care: a scoping review protocol. JMIR Res Protoc. 2012;1(1):e1. doi: 10.2196/resprot.1993.
    1. Archambault PM, Légaré F, Lavoie A, Gagnon M, Lapointe J, St-Jacques S, Poitras J, Aubin K, Croteau S, Pham-Dinh M. Healthcare professionals' intentions to use wiki-based reminders to promote best practices in trauma care: A survey protocol. Implement Sci. 2010;5:45. doi: 10.1186/1748-5908-5-45.
    1. van de Belt Tom H. Faber MJ, Knijnenburg José M L. van Duijnhoven Noortje T L. Nelen Willianne L D M. Kremer Jan A M Wikis to facilitate patient participation in developing information leaflets: first experiences. Inform Health Soc Care. 2014 Mar;39(2):124–39. doi: 10.3109/17538157.2013.872107.
    1. Gupta S, Wan FT, Newton D, Bhattacharyya OK, Chignell MH, Straus SE. WikiBuild: A new online collaboration process for multistakeholder tool development and consensus building. J Med Internet Res. 2011;13(4):e108. doi: 10.2196/jmir.1833.
    1. Witteman HO, Dansokho SC, Colquhoun H, Coulter A, Dugas M, Fagerlin A, Giguere AM, Glouberman S, Haslett L, Hoffman A, Ivers N, Légaré France, Légaré Jean, Levin C, Lopez K, Montori VM, Provencher T, Renaud J, Sparling K, Stacey D, Vaisson G, Volk RJ, Witteman W. User-centered design and the development of patient decision aids: protocol for a systematic review. Syst Rev. 2015;4:11. doi: 10.1186/2046-4053-4-11.
    1. Elkin PL. Human Factors Engineering in HI: So What? Who Cares? and What's in It for You? Healthc Inform Res. 2012 Dec;18(4):237–41. doi: 10.4258/hir.2012.18.4.237.
    1. Gurses AP, Ozok AA, Pronovost PJ. Time to accelerate integration of human factors and ergonomics in patient safety. BMJ Qual Saf. 2012 Apr;21(4):347–51. doi: 10.1136/bmjqs-2011-000421.
    1. Goodson L, Vassar M. An overview of ethnography in healthcare and medical education research. J Educ Eval Health Prof. 2011;8:4. doi: 10.3352/jeehp.2011.8.4.
    1. Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barratt A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moumjid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T, International Patient Decision Aids Standards (IPDAS) Collaboration Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006 Aug 26;333(7565):417. doi: 10.1136/.
    1. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 2000 Dec 15;25(24):3186–91.
    1. Faulkner L. Beyond the five-user assumption: Benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput. 2003 Aug;35(3):379–83.
    1. Gouvernement du Québec Loi Concernant les Soins de fin de vie. [2016-02-02]. .
    1. Lu C, Johantgen M. Factors associated with treatment restriction orders and hospice in older nursing home residents. J Clin Nurs. 2011 Feb;20(3-4):377–87. doi: 10.1111/j.1365-2702.2010.03346.x.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa