DEVELOPMENT OF A DECISION AID FOR CARDIOPULMONARY RESUSCITATION USING USER-CENTERED DESIGN AND A WIKI PLATFORM FOR RAPID PROTOTYPING (PHASE 1)
To assess critical care specialits and intensive care unit (ICU) patients' needs for better evidence and value based decision making prior to the development of a cardiopulmonary resuscitation (CPR) decision aid adjustable to patients' characteristics.
Method(s):
This study took place in the ICU at the Hôtel-Dieu de Lévis (Canada), a closed medical and surgical ICU with 18 beds and staffed by 5 critical care specialists. We conducted three weeks of observation of patients, family members, intensivists and other allied health professionals discussions about advance care planning. We specifically observed 5 dyads of attending intensivists and patients discussing the difficult choice between conducting cardiopulmonary resuscitation (CPR) or no CPR in the case of cardiac arrest. We also interviewed 5 intensivists about their needs for easier and better decision making between CPR and no CPR.
We then employed user centered design and rapid prototyping to explore different ways to explain the risks and benefits of CPR to patients. We also explored different ways to elicit patients' values and preferences. We interviewed 9 patients about the acceptability and relevance of the information presented. Discussions between intensivists and patients were recorded and a standardised observation grid was used to collect patients’ comments and sociodemographic data. Field notes, verbatim and content extracted from the observation grids were content-analyzed.
Our observations and rapid prototyping will inform the adaption of different existing decision aids in various formats (paper, video, web). We will house the different versions of our decision aid in a wiki that will enable future adjustments of our tool to various contexts and patients characteristics.
Result(s):
Our qualitative content analysis revealed that patients and their family members are most concerned about the risks of losing functional autonomy following successful CPR. However, they lack knowledge about the purpose of CPR, the survival rate and functional outcomes after CPR. We also observed a lag between the level of care documented in the patient’s chart and their values, preferences and medical condition.
Conclusion(s):
Basic understanding of what is a cardiac arrest, what is CPR and the risks and benefits of CPR is needed in order to reach a free and informed concern. Use of different formats of decision aid could improve advance care planning communication between intensivists and patients.