The ICU Care Plan: Human-Centered Design of a Tool to Support Time-Limited Trials for Older Adults With Critical Illness.

Abstract

Background: For older adults with critical illness, decisions about life-sustaining therapies can be challenging. A time-limited trial (TLT) is a collaborative care plan endorsed by experts in palliative and critical care to help navigate these challenges. TLTs entail trying life-sustaining therapy for a defined duration. Response to treatment then informs whether to continue recovery-directed care or shift focus exclusively to comfort. TLTs require collaboration among clinicians, patients, and/or surrogate decision makers, yet there is little practical guidance on how to accomplish this. Thus, we sought to design a collaborative TLT planning tool and characterize its valued characteristics.

Methods: In this qualitative study framed by human-centered Design Thinking, we conducted a series of semi-structured interviews (n = 25) and focus groups (n = 5) with 28 participants who were (1) older adults (age ≥ 65) with serious illness, (2) adults of any age with surrogate decision-making experience for an older adult, and/or (3) intensive care unit (ICU) physicians. We purposively sampled across a Midwestern state to achieve diverse representation and used the Rigorous and Accelerated Data Reduction (RADaR) technique for qualitative analysis.

Results: We used participants' input to design the ICU Care Plan, a paper-based tool consisting of a fillable template. The tool is designed to guide a collaborative TLT planning conversation among clinicians, patients, and surrogates and then serve as a visual summary of the care plan. Participants endorsed the tool as (1) creating a unified frame of reference for a complex process; (2) promoting transparency; and (3) setting and managing expectations. The tool exemplifies participants' design priorities of simplicity and flexibility.

Conclusions: We used a human-centered design process to develop a tool for in-the-moment TLT planning that is endorsed by older adults, surrogates, and ICU physicians. Low technology, intentionally simple interventions are a promising approach to promote patient- and family-centered collaboration.