Patient and Family Communication in the Intensive Care Unit (ICU): Development and Usability Testing of the VoiceLove Mobile Phone App to Study Delirium Risk

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Abstract RATIONALE: Increased family engagement has been associated with decreased delirium prevalence in the ICU and is a key pillar of the ABCDEF bundle. Digital tools are needed to address barriers to in-person family presence and enhance family engagement. VoiceLove is a HIPAA-compliant mobile phone app that enables patients and their families to exchange voice messages securely. For patients who are intubated or unable to communicate, VoiceLove allows family members to deliver real-time voice messages when they are away from the bedside without relying on the clinical team to coordinate calls. We sought to conduct iterative usability testing of VoiceLove with diverse, interdisciplinary stakeholders to refine and optimize this platform for patients, families, and their clinical teams in the adult ICU. METHODS: During one of two testing sessions, healthcare worker and family member participants independently completed a set of standardized tasks focused on basic app functionality with a live prototype and provided feedback on screenshots of new app design concepts under consideration. After task completion, participants completed the System Usability Scale (SUS), a validated 10-item questionnaire used to measure the perceived usability of applications. A standardized SUS score was then calculated with scores ranging from 0 (worst) to 100 (best) with a score of >70 reflecting the industry-accepted range for a usable product. Open-ended feedback on the prototype was elicited from participants and used to revise the VoiceLove app extensively for future investigations. RESULTS: The first session (n=12) included 6 nurses, 1 care partner, 1 chaplain, 1 geriatrician, and 3 ICU fellows. The mean SUS score was 77.5 (SD 11.1). The second session (n=8), conducted 7 months later with a refined prototype, included 6 family members and 2 nurses. The mean SUS score was 75.9 (SD 26.8). Accessibility, navigation, and simplicity were identified as design priorities. Participants identified multiple strengths including the ability to customize messaging by unique family groups and to archive and replay messages. Implementation concerns included the workload burden for nurses and challenges navigating complex family dynamics. CONCLUSIONS: A diverse group of ICU stakeholders found the VoiceLove app had great potential to improve communication with critically ill patients inherently disadvantaged in their ability to communicate. Usability testing of the VoiceLove app was conducted to help prepare for an upcoming randomized controlled trial to evaluate the impact of VoiceLove, as compared to standard care, on family engagement, communication, and the incidence of delirium in ICU patients.

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