Vidatalk Communication Application: Usability, Acceptability and Efficacy Study
Condition: Nonverbal Communication; Critical Illness
MeSH terms: Critical Illness
Study type: Interventional

Summary: 
      This Phase II Small Business Technology Transfer Research (STTR) will deliver a comprehensive
      patient communication solution for communication-impaired patients in the intensive care unit
      that may help decrease days in delirium, decrease anxiety levels, and reduce sedation
      exposure which are proximal outcomes known to be associated with decreased mechanical
      ventilation days, shorter lengths of ICU and hospital stay, and lower healthcare cost. The
      primary goal of this Phase II STTR proposal is to further define user requirements and
      product specifications and develop a prototype of VidaTalk, a patient-centric, touch pad
      communication software, to provide mechanically ventilated (MV) patients an evidence-based
      solution for effectively communicating their needs to care providers and family. A secondary
      goal is to test the impact of the VidaTalk on clinical outcomes. This study will use mixed
      methods including observations and interaction with hospitalized patients as they use the
      VidaTalk tool, surveys and medical record data extraction, product evaluation and brief
      interview, satisfaction surveys with family members of ICU patients, and focus groups with
      Registered Nurses.

      Specific Aim 1. Develop a commercial prototype of VidaTalk that will include multilingual and
      customizable messages, compatibility with tablet devices, picture symbols, and integration
      with mobile communication devices.

      Specific Aim 2. Demonstrate usability with iterative user assessment testing in a clinical
      setting.

      Specific Aim 3. Test the clinical efficacy of VidaTalk via android application with MV
      patients by examining qualitative and quantitative endpoints in a clinical setting. Aim 3
      hypothesis: MV patients using VidaTalk will demonstrate significant reductions in
      patient-reported communication difficulty and frustration, anxiety, sedation exposure,
      delirium/coma-free days, and improved patient and family satisfaction with ICU care compared
      to MV patients receiving attention-control (i.e., tablets with health education application).

      Specific Aim 4. Validation of electronic visual analogue scale, versus current standard paper
      scale.

      Specific Aim 5 a, b and c. Test the effect of the communication tablet (VidaTalk) on
      psychological symptoms in family caregivers.
    

Detailed description: 
      Treatment-induced communication impairment is one of the most common and distressful symptoms
      to mechanically ventilated intensive care unit (ICU) patients and is associated with anxiety,
      panic, anger, frustration, sleeplessness, and distress.This Phase II Small Business
      Technology Transfer Research (STTR) will deliver a comprehensive solution that may help
      decrease days in delirium, decrease anxiety levels, and reduce sedation exposure which are
      proximal outcomes known to be associated with decreased mechanical ventilation days, shorter
      lengths of ICU and hospital stay, and lower healthcare cost. The primary goal of this Phase
      II STTR proposal is to further define user requirements and product specifications and
      develop a prototype of VidaTalk (previously TouchTalk), a patient-centric, touch pad
      communication software, to provide mechanically ventilated (MV) patients an evidence-based
      solution for effectively communicating their needs to care providers and family. A secondary
      goal is to test the impact of the VidaTalk on clinical outcomes (e.g., patient-reported
      communication difficulty and frustration, anxiety, sedation exposure, delirium/coma-free
      days, and improved patient and family satisfaction with ICU care). This study will use mixed
      methods including observations and interaction with hospitalized patients as they use the
      VidaTalk communication tool, surveys and medical record data extraction, product evaluation
      and brief interview, satisfaction survey with family members of ICU patients and focus groups
      with Registered Nurses. Our Phase I STTR successfully delivered a beta prototype that met
      technical feasibility criteria; however, additional requirements emerged as a common theme
      from user testing and market analysis. The current study will meet the identified needs for
      VidaTalk to operate on android devices, be customizable to patients' unique message needs,
      use pictures symbols for communication, and be able to route patient requests to providers
      who are not present at the bedside.

      Specific Aim 1 (Preliminary to Clinical Trial). Develop a commercial prototype of VidaTalk
      that will include multilingual and customizable messages, compatibility with tablet devices,
      picture symbols, and integration with mobile communication devices.

      Specific Aim 2 (Preliminary to Clinical Trial). Demonstrate usability with iterative user
      assessment testing in a clinical setting.

      Specific Aim 3. Test the clinical efficacy of VidaTalk via android application with MV
      patients by examining qualitative and quantitative endpoints in a clinical setting. Aim 3
      hypothesis: MV patients using VidaTalk will demonstrate notable reductions in
      patient-reported frustration and communication difficulty, anxiety, sedation exposure,
      delirium/coma-free days, and improved patient and family satisfaction with ICU care compared
      to MV patients receiving attention-control.

      Specific Aim 4. Validation of electronic visual analogue scale, versus current standard paper
      scale.

      Specific Aim 5. Test the effect of the communication tablet (VidaTalk) on psychological
      symptoms in family caregivers.
    

Intervention name(s): Aim 1 - VidaTalk - post-extubation; Aim 2 - VidaTalk - intubated; Aim 3 - VidaTalk tablet app; Aim 3 - attention-control with non-VidaTalk tablet
Intervention type(s): Other; Other; Device; Other
Intervention description(s): Observation of task completion will be made while patients complete a series of messages using the VidaTalk app:
Tell me you are tired
Tell me you are having pain
Rate this pain
Tell me there is pain in your back
Tell me your pain is sharp
Ask to see the doctor
Write your favorite color by drawing with your finger
Type "How are you?" Patients will also complete a 1-item difficulty rating and a 3-item After-Scenario Questionnaire (ASQ) after each task.
Patients will also be asked to (a) comment on the customization of the app and make suggestions; (b) rate the extent to which they would use the device if they were an ICU patient and unable to speak.
Group 1 only:
Patients will be asked about their preferences for customizing the VidaTalk app.; Usability testing prior to clinical trial. The company will have performed further iterative design assessments and engineered a Vidatalk tablet application prototype for a field-test for functionality (human-device interaction factors, feasibility, and usability) and acceptability. Data will be collected by a trained data collector as in Aim 1 with the addition of Ease of Communication and Frustration ratings before and after the testing sequence. To reduce burden, patients in this group will complete the 3-item ASQ one time after all tasks are completed. They will also complete a 13-item System Usability Scale (SUS).; Patients in the intervention group will receive a protocolized instruction in the use of the VidaTalk application and mounting of the device including patient return demonstration of key features, and review/ testing to competence conducted by a trained interventionist. When available, a family member may be included in surveys about the patients hospital stay, if patient agrees. The interventionist will visit patients briefly (5-10 minutes) each day to check user needs and concerns and will review or retrain on message options if needed.; Patents randomized to the control group will receive a protocolized introduction to the bedside Android device without the VidaTalk app, focusing instead on a common tablet application. Daily visits will be conducted with control group patients to query on use of the attention-control tablet.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Vidatalk; App; Augmentative and Alternative Communication; iPad; Android; Mechanical ventilation; Patient Communication; Critical Illness