Usability of a Video Support Tool to Elicit Patient Preferences in a Medical ICU

Significance: The state of the science of Advance Care Planning in the acute or critical care setting urges care givers to elicite patients’ goals as the standard of care. (Kelley & Morrison, 2015; Kavalieratos et al., 2016; Center to Advanced Palliative Care, 2020; National Consensus Project for Quality Palliative Care, 2018; Committee on Approaching Death, 2015). However, evidence is equivocal on the optimal approach to goals of care discussions with patients/families in the critical care setting. Video support tools are a more recent and innovative approach to the traditional patient/family in person meeting or communication format.
Purpose: The purpose of this project was to conduct a pilot test of a video support tool in a medical ICU setting. The goals of the project were to assess the feasibility and usability of the Video Support Tool (VST) by critical care nurses, to assess the usability of the VST by patients or surrogate decision makers, and to assess if the VST increased documentation of Advance Care Planning discussions.
Design: The project design was quality improvement. Pre and post VST surveys for patients and/or their surrogate decision makers were utilized to obtain data collection. Due to the significant impact of COVID-19, interventions and data collection a were divided into 2 phases.
Results: 100% of nurses surveyed reported that the implementation of a VST was feasible and easy to use. 85% of patients or surrogate decision makers reported that the VST was helpful and 100% reported they would recommend the VST to other patients. Three of the 20 patients who participated in the project had documentation of Advance Care Planning (ACP) discussions in the Electronic Health Record prior to discharge.
Conclusion: The results of this project support the feasibility and usability of a VST in a medical ICU setting for both nursing and patients or their surrogate decision makers. Overall, the findings of this project cannot support the benefit of using a VST to enhance ACP discussions. In the future, additional evaluation of a VST should be implemented as the emergency diversion of resources subsides in the COVID-19 pandemic so that its potential contributions can be fully understood.