Theoretically Informed Design and Acceptability Evaluation of a Communication Bundle for Adult Intensive Care Unit Patients with an Advanced Airway during Pandemic Conditions
Bibliographic record
Abstract
Background. Communication difficulty is associated with adverse physical and psychological sequelae for intensive care unit (ICU) patients managed with an advanced airway for mechanical ventilation. Supportive communication tools exist; however, few are integrated into practice. COVID-19 pandemic (2020-22) infection prevention and control (IPAC) conditions contribute new barriers to communication warranting solutions. Objectives. To use a theoretically informed study design to create and evaluate the acceptability of a co-designed bundled COmmunication intervention for adult patients with an advanced airway during the COVID-19 PandEmic (COPE) from the perspective of diverse health care professionals (HCP), patients, and family in the adult ICU IPAC context. Design. A sequential multiple study design including a scoping review, an interview study, co-design methods, and a convergent mixed-method acceptability evaluation study in a single adult medical-surgical ICU in Toronto, Canada (January 2020 – March 2021). Methods. The Theoretical Framework of Acceptability was used to consecutively analyze reported barriers to and facilitators for: communication tool use in the adult ICU in the scoping review; and stakeholder support of patient communication in the pandemic ICU context in qualitative interviews. The results from these two studies informed the co-design of the COPE intervention. Finally, the acceptability, appropriateness, and feasibility of COPE were evaluated using mixed-methods. Results. The COPE intervention included 1. Stocked IPAC approved physical communication tool cart, and electronic tool cart, 2. Education modules for HCP, and 3. Information for patient-family connection. COPE was rated and described to be acceptable, appropriate, and feasible. Integration of data sets revealed additional recommendations for COPE including enhanced access to tools and training; leadership support of the physical, cognitive, and emotional impact of communication work; and use of a theoretically informed implementation framework. Conclusion. A theoretical understanding of acceptability of communication interventions such as COPE from the perspective of key stakeholders can inform intervention design, improve acceptability, and potentially advance utilization of communication supportive tools in practice. Relevance to practice. Implications include the availability of an acceptable communication intervention for use and further evaluation, a call to action for communication training, and need for leadership support for ICU HCP and communication work.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.098 | 0.107 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".