Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs

Ernecoff, Natalie C.; Witteman, Holly O.; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin; Shields, Andrew; Myers, Brad A.; Hough, Catherine L.; Carson, Shannon S.; Lo, Bernard; Matthay, Michael A.; Anderson, Wendy G.; Peterson, Michael W.; Steingrub, Jay S.; Arnold, Robert M.; White, Douglas B.

doi:10.1016/j.jcrc.2016.01.030

Cited by 19 publications

(16 citation statements)

References 52 publications

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“…Interventions were grouped based on their distinguishing characteristics (summarised in table 2), and positioned within a continuum of low to high involvement: (i) environmental unit changes (n=2), 16 17 (ii) web-based support (n=4), [18][19][20][21] (iii) discussion-based support (n=6), [22][23][24][25][26][27] (iv) multicomponent support (n=4), [28][29][30][31] (v) participation in rounds (n=3) [32][33][34] and (vi) participation in physical care (n=1). 35 Open access family members and patients being utilised for reciprocal benefit.…”

Section: Intervention Typesmentioning

confidence: 99%

Interventions to promote family member involvement in adult critical care settings: a systematic review

et al. 2021

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ObjectiveTo identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members.DesignMixed-method systematic review.Data sourcesBibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly.ResultsOut of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from −0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from −7.12 to 0.9), family well-being (mean difference ranged from −0.7 to −4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions.ConclusionsFuture interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members’ needs, readiness and preparedness for involvement.PROSPERO registrationCRD42018086325.

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Section: Intervention Typesmentioning

confidence: 99%

Interventions to promote family member involvement in adult critical care settings: a systematic review

et al. 2021

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“…For example, some studies seek to enroll legal surrogate decision-makers[33], others try to identify the person who spends the most time caregiving for the patient[37], and many qualitative studies of ICU families use a convenience sample. [38] A recent review identified 14 randomized controlled trials of interventions designed to better meet the needs of ICU families, including face-to-face meetings, changes in visitation policies, and educational brochures. [39] To interpret the results of these trials it is important to understand how many ICU patients have family members who could potentially benefit from the intervention, and the representativeness of family members enrolled in the trials.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a strategy for enrolling the families of critically ill patients in research using limited human resources

et al. 2017

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RationaleClinical trials of interventions aimed at the families of intensive care unit (ICU) patients have proliferated but recruitment for these trials can be challenging.ObjectivesTo evaluate a strategy for recruiting families of patients currently being treated in an ICU using limited human resources and time-varying daily screening over 7 consecutive daysMethodsWe screened the Johns Hopkins Hospital medical ICU census 7 days per week to identify eligible family members. We then made daily, in-person attempts to enroll eligible families during a time-varying 2-hour enrollment period until families declined participation, consented, or were no longer eligible.Measurements and main resultsThe primary outcome was the proportion of eligible patients for whom ≥1 family member was enrolled. Secondary outcomes included enrollment of legal healthcare proxies, the consent rate among families approached for enrollment, and success rates for recruiting at different times during the day and week. Among 284 eligible patients, 108 (38%, 95% CI 32%-44%) had ≥1 family member enrolled, and 75 (26%, 95% CI 21%-32%) had their legal healthcare proxy enrolled. Among 117 family members asked to participate, 108 (92%, 95% CI 86%-96%) were enrolled. Patients with versus without an enrolled proxy were more likely to be white (44% vs. 30%, P = .02), live in a zip code with a median income of ≥$100,000 (15% vs. 5%, P = .01), be mechanically ventilated (63% vs. 47%, P = .01), die in the ICU (19% vs. 9%, P = .03), and to have longer ICU stays (median 5.0 vs. 1.8 days, P<.001). Day of the week and time of day were not associated with family presence in the ICU or consent rate.ConclusionsFamily members were recruited for more than one third of eligible patients, and >90% of approached consented to participate. There are important demographic differences between patients with vs without an enrolled family member.

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“…With flexibility within training programmes highlighted as essential (Ernecoff et al, 2016), this flexibility should also extend to cover remediation and provision of additional support in areas jointly identified and agreed upon by trainees and trainers to be paramount for targeted improvement. As it is worrying that no studies have focused on the effects of remediation on ICU communication skills training thus far, this should be a critical area for future research considering its importance (Steinert, 2013).…”

Section: E Stage 5 Synthesis Of Systematic Scoping Review In Sebamentioning

confidence: 99%

A systematic scoping review of teaching and evaluating communications in the intensive care unit

Chia

Elisha

Huixin

et al. 2021

TAPS

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Introduction: Whilst the importance of effective communications in facilitating good clinical decision-making and ensuring effective patient and family-centred outcomes in Intensive Care Units (ICU)s has been underscored amidst the global COVID-19 pandemic, training and assessment of communication skills for healthcare professionals (HCPs) in ICUs remain unstructured. Methods: To enhance the transparency and reproducibility, Krishna’s Systematic Evidenced Based Approach (SEBA) guided Systematic Scoping Review (SSR), is employed to scrutinise what is known about teaching and evaluating communication training programmes for HCPs in the ICU setting. SEBA sees use of a structured search strategy involving eight bibliographic databases, the employ of a team of researchers to tabulate and summarise the included articles and two other teams to carry out content and thematic analysis the included articles and comparison of these independent findings and construction of a framework for the discussion that is overseen by the independent expert team. Results: 9532 abstracts were identified, 239 articles were reviewed, and 63 articles were included and analysed. Four similar themes and categories were identified. These were strategies employed to teach communication, factors affecting communication training, strategies employed to evaluate communication and outcomes of communication training. Conclusion: This SEBA guided SSR suggests that ICU communications training must involve a structured, multimodal approach to training. This must be accompanied by robust methods of assessment and personalised timely feedback and support for the trainees. Such an approach will equip HCPs with greater confidence and prepare them for a variety of settings, including that of the evolving COVID-19 pandemic.

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Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs

Cited by 19 publications

References 52 publications

Interventions to promote family member involvement in adult critical care settings: a systematic review

Interventions to promote family member involvement in adult critical care settings: a systematic review

Evaluation of a strategy for enrolling the families of critically ill patients in research using limited human resources

A systematic scoping review of teaching and evaluating communications in the intensive care unit

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