title: Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.
abstract: Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs.
  
  
  
  We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews.
  
  
  
  Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy.
  
  
  
  There is broad support among stakeholders for the use of a tablet-based tool to improve communication and shared decision making in ICUs. Eliciting the perspectives of key stakeholders early in the design process yielded important insights to create a tool tailored to the needs of surrogates and care providers in ICUs.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Ernecoff
authors.affiliation: Department of Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada; Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Research Centre of the CHU de Québec, Quebec City, Quebec, Canada.
authors.forename: Holly O
authors.initials: HO
authors.lastname: Witteman
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Chon
authors.affiliation: Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA.
authors.forename: Yanquan Iris
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Praewpannarai
authors.initials: P
authors.lastname: Buddadhumaruk
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Jared
authors.initials: J
authors.lastname: Chiarchiaro
authors.affiliation: Office of Healthcare Quality Improvement, Saint Clair Hospital, Pittsburgh, PA.
authors.forename: Kaitlin J
authors.initials: KJ
authors.lastname: Shotsberger
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Shields
authors.affiliation: Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA.
authors.forename: Brad A
authors.initials: BA
authors.lastname: Myers
authors.affiliation: Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
authors.affiliation: The Greenwall Foundation, New York, NY.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lo
authors.affiliation: Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.affiliation: Department of Medicine and Division of Hosiptal Medicine and Palliative Care Program, University of California San Francisco, San Francisco, CA.
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Peterson
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, MA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Steingrub
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: whitedb@upmc.edu.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D034201:Computers, Handheld; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D033262:Narration; D010342:Patient Acceptance of Health Care; D010465:Perception; D011368:Professional-Family Relations; D011379:Prognosis; D036301:Qualitative Research
keywords: End-of-life; ICU communication; Qualitative; Surrogate decision makers; User-centered design