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

TL;DR

This paper describes the development of a collaborative care planning tool for older ICU patients, designed to help manage life-sustaining therapies through a human-centered design process.

Contribution

The novel contribution is a low-tech, paper-based ICU Care Plan tool designed through human-centered methods to support time-limited trial planning in critical care.

Findings

The ICU Care Plan tool was valued for creating a unified frame of reference for complex care decisions.

Participants emphasized the tool's ability to promote transparency and manage expectations during TLT planning.

The design process highlighted the importance of simplicity and flexibility in supporting patient-centered collaboration.

Abstract

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.

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.

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.

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.

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