JMIR Publications

ABSTRACT

Background:

In burn care one of the most debated topics is the optimal treatment of patients with deep partial-thickness burns. With these patients the decision must be made to perform early surgery or to wait and potentially limit or even avoid surgery. Both options are available in Dutch burn care, and the best treatment option is decided on clinical outcomes as well as patients’ preferences. This complexity highlights the need for shared decision-making between patients with deep partial-thickness burns and healthcare professionals and a decision aid to facilitate this process.

Objective:

The aim of this study was to support patients with deep partial-thickness burns and healthcare professionals in the process of shared decision-making regarding the decision between early surgery or late/no surgery by developing and implementing a decision aid to facilitate this process.

Methods:

The decision aid was developed using a user-centered mixed-methods design consisting of three phases. Phase 1) The needs of patients and healthcare professionals regarding current information provision, treatment choices, and collaborative decision-making were assessed (needs assessment). Phase 2) The scope, content and design of the decision aid were developed in five co-design sessions with patients, healthcare professionals, and researchers. Usability testing of the concept version of the decision aid was conducted with patients using the think-aloud method. This was followed by acceptability testing with healthcare professionals, after which final adjustments were made. Phase 3) The decision aid was implemented by a six-month pilot period. Evaluation included patient interviews, focus groups with HPs, and the Normalization Measure Development questionnaire to assess the level of normalization.

Results:

The final decision aid consisted of three components: 1) a paper handout sheet; 2) an interactive website; 3) a summary sheet summarizing patient’s values and preferences that were filled in during the decision aid process. During the pilot period, the decision aid was distributed 42 times and used by 28 patients, resulting in a participation rate of 67%. Overall, both patients and healthcare professionals reported the decision aid as helpful and were positive on its use. The decision aid was easily integrated into the care process and there was a positive attitude towards future use of the decision aid.

Conclusions:

Using a comprehensive approach, a decision aid for patients with deep partial-thickness burns was successfully developed and implemented. The decision aid facilitates shared decision-making, improves patient-centered care by providing tailored information, and empowers patients to actively participate in their treatment decisions.