Development and usability testing of a parent decision support tool for the neonatal intensive care unit.
ABSTRACT In this paper we present the development and evaluation of a parent decision support tool for a neonatal intensive care unit (NICU), known as PPADS or Physician and Parent Decision Support. The NICU interprofessional (IP) team uses advanced technology to care for the sickest infants in the hospital, some at the edge of viability. Many difficult care decisions are made daily for this vulnerable population. The PPADS tool, a computerized decision support system, aims to augment current NICU decision-making by helping parents make more informed decisions, improving physician-parent communication, increasing parent decision-making satisfaction, decreasing conflict, and increasing decision efficiency when faced with ethically challenging situations. The development and evaluation of the PPADS tool followed a five step methodology: assessing the clinical environment, establishing the design criteria, developing the system design, implementing the system, and performing usability testing. Usability testing of the PPADS tool with parents of neonates who have graduated (survived) from a tertiary level NICU demonstrates the usefulness and ease of use of the tool.
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ABSTRACT: To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement ('self-efficacy', 'patient empowerment', 'patient activation', or 'patient engagement'), (2) involved health information technology ('technology', 'games', 'electronic health record', 'electronic medical record', or 'personal health record'), and (3) took place in the inpatient setting ('inpatient' or 'hospital'). Only English language studies were reviewed. 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness.Journal of the American Medical Informatics Association 11/2013; 21(4). DOI:10.1136/amiajnl-2013-002141 · 3.93 Impact Factor
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ABSTRACT: Background Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice.Methods We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information.ResultsOne hundred clinicians completed the web surveys. In 54 % of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40 %, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89 % expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6¿±¿1.2, scale 1¿7, with 7 being ¿high¿), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P¿<¿0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear ¿bottom line¿ statement for each Dbox and access to printed Dboxes in consultation rooms.Conclusions Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.Implementation Science 10/2014; 9(1):144. DOI:10.1186/s13012-014-0144-6 · 3.47 Impact Factor
Conference Paper: Usefulness analysis of a Clinical Data Repository design[Show abstract] [Hide abstract]
ABSTRACT: The perceived usefulness of a Clinical Data Repository (CDR) prototype in a hospital setting was assessed by clinicians to determine whether they would find it helpful for their clinical and research work. The CDR automatically collects and stores clinical data in real time from patient monitoring devices, clinical information systems, laboratory systems, and the Health Records Department in a de-identified, easily extractable format for secondary uses. A secure online survey was distributed to physicians, research institute investigators, and research institute coordinators at the Children's Hospital of Eastern Ontario (CHEO) through email. According to the survey responses, participants felt the CDR was a useful tool, showed interest in it, and thought it would be important to have for future work. To illustrate how the CDR could be used in a clinical setting we have provided a sample clinical application; a tool for engaging physicians and parents in discussion about the clinical progress and prognosis of infants in the Neonatal Intensive Care Unit (NICU).Medical Measurements and Applications Proceedings (MeMeA), 2013 IEEE International Symposium on; 01/2013