Developing A Decision Aid for Critically Ill Patients Requiring Renal Replacement Therapy: A User-Centered Approach for Rapid Prototyping (Preprint)

Abstract

BACKGROUND Renal replacement therapy (RRT) is increasingly being adopted as a treatment method for critically ill patients suffering from acute kidney injury, followed by inevitably high rates of morbidity and mortality. Whether or not to choose RRT for critically ill patients is a significant concern for surrogate decision makers and is associated with anxiety and decision dilemmas. While evidence suggests that decision aids (DAs) help to improve the quality of medical decision making, few supports exist in the decision-making process for surrogates when their loved ones in the ICU face the possibility of RRT. OBJECTIVE The objective of this study was to develop a web-based DA to help surrogates make better-informed decisions for critically ill patients requiring RRT. METHODS To develop the DA, we utilized a systematic process to create a user-centered design by following four steps: (1) competitive analysis — identify existing DAs through a systematic environmental scan; (2) users’ needs assessment — explore surrogates’ decisional needs through semi-structured interviews; (3) user persona development — develop a typical user persona through a manual characterization of users’ expectations for DAs; (4) evidence synthesis — synthesize clinical evidence on RRT decision making according to the above requirements. This process was implemented to efficiently solve design issues before the development began, thereby helping developers to determine their goals more readily and to focus on the needs of target users. RESULTS The rapid prototyping of the DA was accomplished through a systematic process and conceiving a user-centered design. (1) Sixteen available DAs related to RRT were identified in the areas of: end-of-life issues (N=2), end stage renal disease (N=5), and chronic kidney disease (N=9). Design decisions for a DA pertaining to RRT for critically ill AKI patients were informed by these methods. (2) Fifteen family surrogates with RRT decision-making experience in an ICU setting were interviewed for the purpose of needs assessment. Users’ potential needs were identified within the domains of professional support, role guidance, information needs, and values clarification. (3) A typical user persona was constructed to help understand users’ needs and to further inform design choices. (4) 27 sources were selected and a total of 21 items were extracted as evidence to augment the content of the prototype. Finally, the DA prototype was designed to include a user guide and a four-step decision guide. CONCLUSIONS We have created a novel approach for the rapid prototyping of a web-based DA that is targeted at family surrogates making decisions about RRT for their loved ones in ICU. Future studies are warranted to evaluate the usability, feasibility, and comprehensibility of the DA through iterative refinement. CLINICALTRIAL ChiCTR2000031613