JMIR Publications

ABSTRACT

Background:

For seriously ill patients, conversations about prognosis, values, and goals can improve person-centered care but these conversations do not happen consistently.

Objective:

We developed an online, interactive goals of care discussion priming tool called MyCare to facilitate conversations about patient goals between doctors, patients, and family members. Our objective was to determine the feasibility, acceptability, and usability of MyCare for seriously ill patients in hospital.

Methods:

We conducted a mixed methods study on internal medicine wards with seriously ill patients at two hospitals. Participants completed MyCare with a research assistant in their hospital room and responses were sent to their attending physician team. Patients, family members, and physicians participated in semi-structured interviews to assess advance care planning engagement, usability, and acceptability. Patients completed the system usability scale (SUS).

Results:

MyCare had moderate usability (SUS 64.7/100). The most useful elements for patients were: 1) clarifying goals and wishes for care, 2) identifying people who support them, and 3) having something to help facilitate conversations with their families. The most useful elements for physicians were seeing patients’ prioritized values and goals. Acceptability and usability could be improved by reducing the length of the tool and removing questions patients felt redundant, or instead increasing free-text spaces for patients to communicate their thoughts more clearly.

Conclusions:

MyCare and similar tools will be more usable and acceptable if they are short, simple, focus on shared doctor-patient priorities, and empower patients to advocate for their own goals.