Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Mar 19, 2023)
Date Submitted: May 26, 2022
Open Peer Review Period: May 26, 2022 - Jul 21, 2022
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Developing A Decision Aid for Critically Ill Patients Requiring Renal Replacement Therapy: A User-Centered Approach for Rapid Prototyping
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. Clinical Trial: ChiCTR2000031613
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.