title: Usability and Acceptability of the QDACT-PC, an Electronic Point-of-Care System for Standardized Quality Monitoring in Palliative Care.
abstract: BACKGROUND
  Few resources exist to support collaborative quality monitoring in palliative care. These tools, if proven efficient through technology-enabled methods, may begin to routinize data collection on quality during usual palliative care delivery. Usability testing is a common approach to assess how easily and effectively users can interact with a newly developed tool.
  
  
  OBJECTIVE
  We performed usability testing of the Quality Data Collection Tool for Palliative Care (QDACT-PC) a novel, point-of-care quality monitoring tool for palliative care.
  
  
  METHODS
  We used a mixed methods approach to assess community palliative care clinicians' evaluations of five domains of usability. These approaches included clinician surveys after recording mock patient data to assess satisfaction; review of entered data for accuracy and time to completion; and thematic review of "think aloud" protocols to determine issues, barriers, and advantages to the electronic system.
  
  
  RESULTS
  We enrolled 14 palliative care clinicians for the study. Testing the electronic system vs. paper-based methods demonstrated similar error rates and time to completion. Overall, 68% of the participants believed that the electronic interface would not pose a moderate or major burden during usual clinical activities, and 65% thought it would improve the care they provided. Thematic analysis revealed significant issues with paper-based methods alongside training needs for future participants on using novel technologies that support the QDACT-PC.
  
  
  CONCLUSIONS
  The QDACT-PC is a usable electronic system for quality monitoring in palliative care. Testing reveals equivalence with paper for data collection time, but with less burden overall for electronic methods across other domains of usability.
authors.affiliation: Division of Medical Oncology and Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA. Electronic address: arif.kamal@duke.edu.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.affiliation: Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburg School of Medicine, Pittsburg, Pennsylvania, USA.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.affiliation: Four Seasons, Flat Rock, North Carolina, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.affiliation: Forsyth Medical Center Palliative Care Services, Winston-Salem, North Carolina, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Stinson
authors.affiliation: Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nicolla
authors.affiliation: Division of Medical Oncology and Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000592:standards*; D010820:Physicians / Q000523:psychology; D019095:Point-of-Care Systems; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards*; D012984:Software; D013997:Time Factors
keywords: Quality monitoring; health services delivery; palliative care