Development of an App to Facilitate Communication and Shared Decision-Making with Parents of Febrile Infants ≤60 Days Old

Affiliations

PMID: 32648270
DOI: 10.1111/acem.14082

Abstract

Objectives: We aimed to develop and test a tool to engage parents of febrile infants ≤60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age.

Methods: We conducted a multi-phase development and testing process: 1) individual, semi-structured interviews with parents and clinicians (pediatric and general emergency medicine (EM) physicians, and pediatric EM nurses) to learn their preferences for a communication and SDM tool; 2) design of a "storyboard" of the tool with design impression testing; 3) development of a software application (i.e., app) prototype, called e-Care; and 4) usability testing of e-Care, using qualitative assessment and the System Usability Scale (SUS).

Results: We interviewed 27 parents and 23 clinicians. Interviews revealed several themes, including: a communication tool should augment but not replace verbal communication; a web-based format was preferred; information about infections and testing, including the rationales for specific tests, would be valuable. We then developed separate versions of e-Care for infants ≤28 days and 29 to 60 days of age, in both English and Spanish. The e-Care app includes 4 sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing, including a table for parents of infants 29 to 60 days of age to compare the risks/benefits of LP in preparation for an SDM conversation. Parents and clinicians reported that e-Care was understandable and helpful. The mean SUS score was 90.3 (95% confidence interval: 84-96.6), representing "excellent" usability.

Conclusions: The e-Care app is a useable and understandable tool to support communication and SDM with parents of febrile infants ≤60 days of age in the ED.