Goals-of-care decision aid for critically ill patients with TBI: Development and feasibility testing

Area of Science:

• Neurology
• Critical Care Medicine
• Medical Decision Making

Background:

• Surrogates for critically ill traumatic brain injury (ciTBI) patients face complex decisions.
• Effective goals-of-care communication is crucial in neurointensive care units (neuroICUs).
• Existing decision aids may not adequately address the needs of this specific patient population.

Purpose of the Study:

• To develop and assess the early feasibility of a novel goals-of-care decision aid for surrogates of ciTBI patients.
• To ensure the decision aid meets international standards for usability and acceptability.
• To evaluate the feasibility of a clinical trial protocol for this decision aid.

Main Methods:

• A four-stage development process including qualitative studies, iterative revisions, and usability testing.
• Involvement of 36 stakeholders (surrogates and physicians) in initial development.
• Acceptability and usability testing with 18 family members in neuroICU waiting rooms.
• An interim analysis of a randomized controlled feasibility trial with 16 surrogates.

Main Results:

• The decision aid achieved excellent usability (median System Usability Scale 87.5) and high acceptability (97% rated content as "good" or "excellent").
• High recruitment (73%), participation (100%), and retention (100%) rates demonstrated early feasibility.
• Complete data for secondary outcomes were collected, indicating feasibility of the trial protocol.

Conclusions:

• A novel goals-of-care decision aid for ciTBI surrogates was successfully developed with excellent usability, acceptability, and feasibility.
• The decision aid meets international standards and is suitable for the neuroICU environment.
• The development methodology can serve as a model for creating other neurological decision aids to enhance shared decision-making.