Handheld Technology to Improve Patient Care: Evaluating a Support System for Preference-based Care Planning at the Bedside

Objective: Despite an increasing movement toward shared decision making and the incorporation of patients'' preferences into health care decision making, little research has been done on the development and evaluation of support systems that help clinicians elicit and integrate patients'' preferences into patient care. This study evaluates nurses'' use of choice, a handheld-computer–based support system for preference-based care planning, which assists nurses in eliciting patients'' preferences for functional performance at the bedside. Specifically, it evaluates the effects of system use on nurses'' care priorities, preference achievement, and patients'' satisfaction.Design: Three-group sequential design with one intervention and two control groups (N=155). In the intervention group, nurses elicited patients'' preferences for functional performance with the handheld-computer–based choice application as part of their regular admission interview; preference information was added to patients'' charts and used in subsequent care planning.Results: Nurses'' use of choice made nursing care more consistent with patient preferences (F=11.4; P<0.001) and improved patients'' preference achievement (F=4.9; P<0.05). Furthermore, higher consistency between patients'' preferences and nurses'' care priorities was associated with higher preference achievement (r=0.49; P<0.001).Conclusion: In this study, the use of a handheld-computer–based support system for preference-based care planning improved patient-centered care and patient outcomes. The technique has potential to be included in clinical practice as part of nurses'' routine care planning.With the recent movement toward shared decision making in health care, a number of models, methods, and evaluative strategies to foster shared decision making have been developed. In the clinical, health services, and methodological literature, shared decision making refers to the concept of involving patients and their health care providers in making treatment decisions that are informed by the best available evidence about treatment options and that consider patients'' preferences.Devices to assist patients in shared decision making have been called “decision aids,”¹ and cumulative evidence supports their effectiveness. Studies evaluating decision aids for patients have reported higher scores on cognitive functioning and social support,² more active and satisfying participation in decision making,³ better scores on general health perceptions and physical functioning,⁴ improved knowledge,⁵ and reduced decisional conflict.¹ However, decision aids have so far been confined to the relatively narrow segment of decisions about single episodes of screening or treatment choices. Little attention has been given to the development of systems that help clinicians elicit and integrate patients'' preferences into the ongoing processes of care over time and as part of clinical practice.Although decision aids have been shown to be helpful to patients, it has been argued that decision support systems for eliciting patients'' preferences could also support clinicians in making care decisions consistent with patients'' preferences, and that successful efforts in this direction would lead to better patient outcomes.^6,7 However, the development of decision support systems designed to support clinicians in eliciting and integrating patients'' preferences into their clinical practice has received little attention. Developments of decision support systems for clinicians have mainly been devoted to knowledge-based systems designed to produce patient-specific options and recommendations, such as computer-based clinical guidelines. Other examples of clinical decision support systems include systems that apply rules to detect undesirable trends and events during treatment, offer reminders and messages about diagnostic and therapeutic possibilities, and alert clinicians to potential serious situations.⁸Evidence shows that clinical decision support systems can enhance clinicians'' compliance with system recommendations and to some degree improve clinical patient outcomes.^9,10 Yet such systems rarely offer systematic methods for eliciting patients'' preferences or incorporate algorithms for the integration of patients'' preferences into care planning. Furthermore, there has been only limited research addressing 1) whether the use of computer-based decision support systems to assist in the elicitation of patients'' preferences would in fact prompt clinicians to make care decisions consistent with patients'' preferences, and 2) whether decisions based on the use of such tools would improve patient outcomes. Developing and testing the effects of clinical support systems for preference elicitation and care planning on clinical decisions and patient outcomes can, therefore, make an important contribution to research in this area and, ultimately, to patient-centered care.This paper reports the results of nurses'' use of Choice (Creating better Health Outcomes by Improving Communication about Patients'' Expectations), a handheld-computer–based support system for preference-based care planning, which helps nurses elicit patients'' preferences for functional performance at the bedside—specifically, the effects of its use on nurses'' care priorities and patient outcomes of preference achievement and satisfaction.