Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation.


BACKGROUND: Web-based decision aids are increasingly important in medical research and clinical care. However, few have been studied in an intensive care unit setting. The objectives of this study were to develop a Web-based decision aid for family members of patients receiving prolonged mechanical ventilation and to evaluate its usability and acceptability. METHODS: Using an iterative process involving 48 critical illness survivors, family surrogate decision makers, and intensivists, we developed a Web-based decision aid addressing goals of care preferences for surrogate decision makers of patients with prolonged mechanical ventilation that could be either administered by study staff or completed independently by family members (Development Phase). After piloting the decision aid among 13 surrogate decision makers and seven intensivists, we assessed the decision aid's usability in the Evaluation Phase among a cohort of 30 surrogate decision makers using the Systems Usability Scale (SUS). Acceptability was assessed using measures of satisfaction and preference for electronic Collaborative Decision Support (eCODES) versus the original printed decision aid. RESULTS: The final decision aid, termed 'electronic Collaborative Decision Support', provides a framework for shared decision making, elicits relevant values and preferences, incorporates clinical data to personalize prognostic estimates generated from the ProVent prediction model, generates a printable document summarizing the user's interaction with the decision aid, and can digitally archive each user session. Usability was excellent (mean SUS, 80 ± 10) overall, but lower among those 56 years and older (73 ± 7) versus those who were younger (84 ± 9); p = 0.03. A total of 93% of users reported a preference for electronic versus printed versions. CONCLUSIONS: The Web-based decision aid for ICU surrogate decision makers can facilitate highly individualized information sharing with excellent usability and acceptability. Decision aids that employ an electronic format such as eCODES represent a strategy that could enhance patient-clinician collaboration and decision making quality in intensive care.





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Publication Info

Cox, Christopher E, Nicholas G Wysham, Brenda Walton, Derek Jones, Brian Cass, Maria Tobin, Mattias Jonsson, Jeremy M Kahn, et al. (2015). Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation. Ann Intensive Care, 5. p. 6. 10.1186/s13613-015-0045-0 Retrieved from

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Christopher Ethan Cox

Professor of Medicine

My work is conducted as a clinician, researcher, teacher, and administrator at Duke University.  Currently, I am an Associate Professor of Medicine, the director of Duke’s Medical Intensive Care Unit (MICU), and the Director of the Duke Program to Support People and Enhance Recovery (ProSPER).  My clinical work is based in ICUs at Duke University, though I am also a board-certified palliative medicine specialist.

My research focuses on understanding and improving the experience of critical illness and quality of care for patients, their families and loved ones, clinicians, and society in general.  To do this, my work addresses topics and methodologies including health services research, behavioral and psychological concerns, communication improvement, technological development, and decision making support—all in the context of critical care and palliative medicine.  My extensive training in clinical and health services research methodology and healthcare information technology allows me to do this. 

Key interests:  Critical care, healthcare information technology, health administration and policy, decision making, health economics, mechanical ventilation, palliative care, chronic critical illness / prolonged mechanical ventilation, critical care echocardiography


Derek Jones


I am currently the product manager for myRESEARCHhome, a CTSA funded portal for the Duke University research community. My work involves understanding the needs of researchers across the university through focus groups and outreach, recognizing opportunities and identifying themes across needs, and then designing and implementing technological solutions and business process change that results in meaningful improvement.

Prior to this work, I was a Research Program Leader in Pulmonary Critical Care Medicine. I specialized in research involving critically ill patients and their family members that focused on improved, shared decision making while in the ICU and increased psychological support during post-discharge recovery. 

I have a Master in Divinity (MDiv) degree from Duke Divinity School where my research specialized in Gender, Sexuality, and Theology; Critical Race Theory and Christianity; and homiletics and the concept of preaching truth to power. I am a licensed Lay Preacher in the Episcopal Church.

As a descendent of Mexican immigrants, I am very interested in immigration policies and responses, particularly in the Sanctuary Movement in the United States. I actively participate in local Sanctuary efforts.

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