Development of an App to Facilitate Communication and Shared Decision‐making With Parents of Febrile Infants ≤ 60 Days Old

Abstract

Objectives We aimed to develop and test a tool to engage parents of febrile infants ≤ 60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision‐making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. Methods We conducted a multiphase development and testing process: 1) individual, semistructured interviews with parents and clinicians (pediatric and general emergency medicine [EM] physicians and pediatric EM nurses) to learn their preferences for a communication and SDM tool; 2) design of a “storyboard” of the tool with design impression testing; 3) development of a software application (i.e., app) prototype, called e‐Care; and 4) usability testing of e‐Care, using qualitative assessment and the system usability scale (SUS). Results We interviewed 27 parents and 23 clinicians. Interviews revealed several themes, including that a communication tool should augment but not replace verbal communication; a Web‐based format was preferred; and information about infections and testing, including the rationales for specific tests, would be valuable. We then developed separate versions of e‐Care for infants ≤ 28 days and 29 to 60 days of age, in both English and Spanish. The e‐Care app includes four sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing, including a table for parents of infants 29 to 60 days of age to compare the risks/benefits of LP in preparation for an SDM conversation. Parents and clinicians reported that e‐Care was understandable and helpful. The mean SUS score was 90.3 (95% confidence interval = 84 to 96.6), representing “excellent” usability. Conclusions The e‐Care app is a useable and understandable tool to support communication and SDM with parents of febrile infants ≤ 60 days of age in the ED.

Optimising GPs’ communication of advice to facilitate patients’ self-care and prompt follow-up when the diagnosis is uncertain: a realist review of ‘safety-netting’ in primary care

“…Safety-netting advice should be comprehensible (CMOC7),49 62 65 77 83 95 102 107 memorable (CMOC8),14 57 accompanied by materials allowing the patient to revisit it (CMOC9),26 27 47 49 53 55–57 59 62 63 65 77 88 89 98–100 103 107–112 and given consistently when there is uncertainty irrespective of the perceived risk of the clinical presentation (CMOC10) 27 63. Avoiding jargon, abbreviations and using language that could be easily understood were important but patients did not want their clinician to omit technical information that could facilitate understanding 77.…”

Breaking through barriers: the need for effective research to promote language‐concordant communication as a facilitator of equitable emergency care

“… 55 , 56 SDM in the ED can be facilitated with the use of decision aids, few of which have been studied with patients with LEP. 57 Best practices to engage patients with LEP in SDM in the ED have not been explored. 58 …”

“…55,56 SDM in the ED can be facilitated with the use of decision aids, few of which have been studied with patients with LEP. 57 Best practices to engage patients with LEP in SDM in the ED have not been explored. 58 Even when readily available, professional interpretation is not consistently used throughout the ED visit.…”

Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol

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