To field-test a preliminary digital decision aid (DA) for critically ill severe acute stroke (SAS) patients to understand acceptability and usability, and obtain feedback from surrogate decision-makers.

Shared decision making (SDM) has been recommended for important decisions in ICUs by many professional societies and the Institute of Medicine. We have recently developed a paper-based SDM tool (decision aid [DA]) for surrogates of severe acute ischemic and hemorrhagic stroke (SAS) patients facing the life-or-death goals-of-care decision using stakeholder input. Then we converted this DA to a digital, web-based tool to increase accessibility and portability to allow surrogates, who are often geographically separated, to partake in SDM. We sought to obtain feedback from surrogates on this tool and understand its acceptability and usability.

We recruited 9 surrogates over a period of 3 weeks. Median total usage time was 26 minutes (25-31). Several participants had minor navigational issues during use but adjusted quickly. Median SUS was 90 (where SUS >68/100 is considered “good usability”). On the acceptability scale, 91% of participants graded the DA as good or excellent, with all subcategories scored favorably between 78-100%. Notable surrogate feedback included a particular appreciation for the worksheet and criticism of the DA as text-heavy.

Our pilot digital DA achieved high usability and acceptability. However, the current DA needs a reduction in text and an improved user interface to optimize the user experience. We are currently applying for funding to refine our digital DA and perform feasibility testing.