title: Key stakeholders' perspectives on a Web-based advance care planning tool for advanced lung disease.
abstract: OBJECTIVE
  There is a paucity of scalable advance care planning strategies that achieve the diverse goals of patients, families, and clinicians. We convened key stakeholders to gain their perspectives on developing a Web-based advance care planning tool for lung disease.
  
  
  METHODS
  We conducted semistructured interviews with 50 stakeholders: 21 patients with lung disease, 18 surrogates, and 11 clinicians. Interviews explored stakeholders' desired content and design features of a Web-based advance care planning tool. Participants also rated the tool's acceptability and potential usefulness. We analyzed the interviews with modified grounded theory and validated themes through member checking.
  
  
  RESULTS
  Stakeholders highly rated the acceptability (median, 5; interquartile range, 5-5) and potential usefulness (median, 5; interquartile range, 4-5) of a Web-based tool. Interviewees offered several suggestions: (1) use videos of medical scenarios and patient narratives rather than text, (2) include interactive content, and (3) allow the user control over how much they complete in 1 sitting. Participants identified challenges and potential solutions, such as how to manage the emotional difficulty of thinking about death and accommodate low computer literacy users.
  
  
  CONCLUSIONS
  There is strong stakeholder support for the development of a Web-based advance care planning tool for lung disease.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh PA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA. Electronic address: chiarchiaroj@upmc.edu.
authors.forename: Jared
authors.initials: J
authors.lastname: Chiarchiaro
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Ernecoff
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Praewpannarai
authors.initials: P
authors.lastname: Buddadhumaruk
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Rak
authors.affiliation: Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh PA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh PA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA; Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003142:Communication; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D020407:Internet; D008171:Lung Diseases / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011634:Public Health
keywords: Communication; Decision making; End of life care; Public health