title: Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation.
abstract: 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.
authors: 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.
authors: Christopher E
authors: CE
authors: Cox
authors: 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.
authors: Nicholas G
authors: NG
authors: Wysham
authors: 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.
authors: Brenda
authors: B
authors: Walton
authors: 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.
authors: Derek
authors: D
authors: Jones
authors: Information Technologist, Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors: Brian
authors: B
authors: Cass
authors: Information Technologist, Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors: Maria
authors: M
authors: Tobin
authors: Information Technologist, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors: Mattias
authors: M
authors: Jonsson
authors: Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA.
authors: Jeremy M
authors: JM
authors: Kahn
authors: Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA.
authors: Douglas B
authors: DB
authors: White
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA USA.
authors: Catherine L
authors: CL
authors: Hough
authors: Department of Medicine, Division of General Internal Medicine, University of Colorado, Denver, CO USA.
authors: Carmen L
authors: CL
authors: Lewis
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors: Shannon S
authors: SS
authors: Carson
keywords: Chronic critical illness; Critical illness; Decision aid; Decision support; Patient reported outcomes; Patient-centeredness; Prolonged mechanical ventilation; Surrogate decision making; Usability