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Development and usability testing of Understanding Stroke, a tailored life-sustaining treatment decision support tool for stroke surrogate decision makers

BMC palliative care, 2020-07, Vol.19 (1), p.110-110, Article 110 [Peer Reviewed Journal]

COPYRIGHT 2020 BioMed Central Ltd. ;2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;The Author(s) 2020 ;ISSN: 1472-684X ;EISSN: 1472-684X ;DOI: 10.1186/s12904-020-00617-x ;PMID: 32689982

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  • Title:
    Development and usability testing of Understanding Stroke, a tailored life-sustaining treatment decision support tool for stroke surrogate decision makers
  • Author: Chen, Emily P ; Arslanian-Engoren, Cynthia ; Newhouse, William ; Egleston, Diane ; Sahgal, Savina ; Yande, Aneesha ; Fagerlin, Angela ; Zahuranec, Darin B
  • Subjects: Care and treatment ; Clinical decision making ; Councils ; Decision making ; Decision Support Techniques ; Family - psychology ; Feedback ; Focus groups ; Focus Groups - methods ; Goals ; Health care ; Hemorrhage ; Hospitalization ; Hospitals ; Humans ; Models, Biological ; Palliative care ; Patient-centered care ; Patients ; Prognosis ; Qualitative Research ; Social workers ; Stroke ; Stroke - complications ; Stroke - psychology ; Stroke - therapy ; Usability testing ; User-Centered Design
  • Is Part Of: BMC palliative care, 2020-07, Vol.19 (1), p.110-110, Article 110
  • Description: Surrogate decision makers of stroke patients are often unprepared to make critical decisions on life-sustaining treatments. We describe the development process and key features for the Understanding Stroke web-based decision support tool. We used multiple strategies to develop a patient-centered, tailored decision aid. We began by forming a Patient and Family Advisory Council to provide continuous input to our multidisciplinary team on the development of the tool. Additionally, focus groups consisting of nurses, therapists, social workers, physicians, stroke survivors, and family members reviewed key elements of the tool, including prognostic information, graphical displays, and values clarification exercise. To design the values clarification exercise, we asked focus groups to provide feedback on a list of important activities of daily living. An ordinal prognostic model was developed for ischemic stroke and intracerebral hemorrhage using data taken from the Virtual International Stroke Trials Archive Plus, and incorporated into the tool. Focus group participants recommended making numeric prognostic information optional due to possible emotional distress. Pie charts were generally favored by participants for graphical presentation of prognostic information, though a horizontal stacked bar chart was also added due to its prevalence in stroke literature. Plain language descriptions of the modified Rankin Scale were created to accompany the prognostic information. A values clarification exercise was developed consisting of a list of 13 situations that may make an individual consider comfort measures only. The final version of the web based tool (which can be viewed on tablets) included the following sections: general introduction to stroke, outcomes (prognostic information and recovery), in-hospital and life-sustaining treatments, decision making and values clarification, post-hospital care, tips for talking to the health care team, and a summary report. Preliminary usability testing received generally favorable feedback. We developed Understanding Stroke, a tailored decision support tool for surrogate decision makers of stroke patients. The tool was well received and will be formally pilot tested in a group of stroke surrogate decision makers. ClinicalTrials.gov ( NCT03427645 ).
  • Publisher: England: BioMed Central Ltd
  • Language: English
  • Identifier: ISSN: 1472-684X
    EISSN: 1472-684X
    DOI: 10.1186/s12904-020-00617-x
    PMID: 32689982
  • Source: SpringerOpen
    Geneva Foundation Free Medical Journals at publisher websites
    MEDLINE
    PubMed Central
    ROAD: Directory of Open Access Scholarly Resources
    ProQuest Central
    DOAJ Directory of Open Access Journals
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