Development of an App to Facilitate Communication and Shared Decision‐making With Parents of Febrile Infants ≤ 60 Days Old. (9th September 2020)

• Record Type: Journal Article
• Authors: Aronson, Paul L.; Politi, Mary C.; Schaeffer, Paula; Fleischer, Eduardo; Shapiro, Eugene D.; Niccolai, Linda M.; Alpern, Elizabeth R.; Bernstein, Steven L.; Fraenkel, Liana
• Editors: Cloutier, Robert
• Is Part Of: Academic emergency medicine. Volume 28:Number 1(2021)
• Page Start: 46
• Page End: 59
• Publication Date: 2020-09-09
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.14082
• Languages: English
• ISSNs: 1069-6563

Abstract

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 multiphase development and testing process: 1) individual, semistructured 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 that a communication tool should augment but not replace verbal communication; a Web‐based format was preferred; and 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 four 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 to 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.