JMIR Publications

ABSTRACT

Background:

Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (e.g., dementia) cognitive aging. While its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes, and by assisting them in clarifying their personal values in relation to the decision to be made.

Objective:

To incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI.

Methods:

We conducted a rapid review to identify options to maintain/improve cognitive functions in individuals with MCI. We structured the evidence into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. We used qualitative and user-centered evaluations to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI and their caregivers to evaluate the decision aid in six consecutive rounds, with new participants in each round. We collected quantitative data using the “Values Clarity” and “Informed” subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire and a five-point satisfaction rating scale. We verified comprehension of the information using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. We used an inductive thematic qualitative analysis approach to identify and describe issues that arose. After each round, an expert panel met to prioritize the issues and find solutions to mitigate them. An integrated analysis was conducted to confirm our choices.

Results:

Seven clinicians (social workers, nurses, family physician, psychologist) and 12 older (60+) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed three major issues. First, the user should be guided through the decision making process by tailoring the options’ presentation to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language and pictograms. Third, the interface should be intuitive and user-friendly, utilize popup windows and info-tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings.

Conclusions:

This project resulted in a promising web-based decision aid that can support decision making for a course of action for MCI, based on the users’ personal values and preferences. Further ongoing research will allow its implementation to be tested in clinical settings.