A Pilot Randomized Trial of an Interactive Web-based Tool to Support Surrogate Decision Makers in the Intensive Care...

Area of Science:

• Medical Informatics
• Patient Communication
• Critical Care Medicine

Background:

• Clinician-family communication breakdowns are frequent in intensive care units (ICUs).
• Existing interventions to improve communication are difficult to scale.
• Effective communication is crucial for surrogate decision-making in critical care.

Purpose of the Study:

• To evaluate the feasibility, usability, acceptability, and perceived effectiveness of a novel communication intervention.
• The intervention combines proactive family meetings with a web-based tool for surrogate preparation.
• To assess the impact of the tool on communication quality and shared decision-making.

Main Methods:

• A randomized trial comparing the Family Support Tool with enhanced usual care in two ICUs.
• Participants included surrogates of high-risk incapacitated patients.
• Outcomes measured feasibility (tool access, engagement), usability (System Usability Scale), acceptability, perceived effectiveness, and communication quality.

Main Results:

• 96% of intervention surrogates accessed the tool before the first meeting, with high usability (82.4/100), acceptability (4.5/5), and perceived effectiveness (4.4/5).
• While not statistically significant, the intervention group reported higher quality of communication and shared decision-making.
• The tool demonstrated feasibility for deployment in ICU settings.

Conclusions:

• An interactive web-based tool is feasible for supporting ICU surrogates.
• The Family Support Tool is rated highly usable, acceptable, and effective by surrogates and clinicians.
• This intervention shows promise for improving communication and shared decision-making in critical care.