Development of an Advance Care Planning Portal-Based Tool for Community-Dwelling Persons Living With Cognitive Impairment: The ACPVoice Tool | JoVE Visualize

Development of an Advance Care Planning Portal-Based Tool for Community-Dwelling Persons Living With Cognitive Impairment: The ACPVoice Tool

Jennifer Gabbard^1,2, Ashley E Strahley³, Nicholas M Pajewski^2,4

¹Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

The American Journal of Hospice & Palliative Care|October 14, 2022

View abstract on PubMed

Summary

Developing the ACPVoice tool, an advance care planning (ACP) patient portal, improved comprehension for persons living with cognitive impairment (PLCI). User feedback led to revisions enhancing engagement in ACP discussions.

Area of Science:

Gerontology
Health Informatics
Cognitive Science

Background:

Patient portals offer innovative avenues for advance care planning (ACP).
Cognitive impairment in older adults poses challenges for technology adoption and engagement in ACP.
Developing user-centered tools is crucial for effective patient engagement.

Purpose of the Study:

To develop an advance care planning (ACP) portal-based tool (ACPVoice) for community-dwelling persons living with cognitive impairment (PLCI).
To engage end-users throughout the design process to address comprehension and judgment barriers.
To ensure the tool's content validity and usability for the target population.

Main Methods:

Two rounds of cognitive interviews were conducted with PLCI and their care partners.
Purposive sampling enrolled 15 participants (5 PLCI, 5 dyads) per round.
Interviews assessed comprehension, judgment, and response validity for ACP questions via a patient portal.

Main Results:

Twenty PLCI and ten care partners participated in cognitive interviews.
Major issues identified included unclear wording and undefined terms.
Revisions focused on improving item wording, response options, instructions, and navigation.

Conclusions:

Minor revisions to wording, format, and response options significantly enhanced the interpretability of the ACPVoice tool.
The ACPVoice tool has the potential to facilitate advance care planning discussions among community-dwelling PLCI.
User-centered design is effective in overcoming technological barriers for cognitively impaired individuals in healthcare settings.