Vidatalk Communication Application: Usability, Acceptability and Efficacy Study

Aim 3 - Calculated mean of daily measure by patient mark (x) or point on the Visual Analogue Scale for anxiety, a 100 mm vertical line ranging from 0 ("not anxious at all") to 10 ("most anxious I've ever been").

Aim 3 - This will be the calculated mean of the daily Communication Frustration scale - a single item scale reported by the patient, ranging from 0 "not frustrating" to 4 "extremely frustrating"

Used in Aim 3 only. Calculation of benzodiazepine and morphine equivalents (for opiates) using hospital conversion charts (pharmacy conversion chart). All benzo IV doses were converted to Lorazepam IV doses. All opioid IV doses were converted to morphine IV doses. All benzo oral doses were converted to Lorazepam oral doses. All opioid oral doses were converted to morphine oral doses. Oral doses were converted to IV equivalents. Summed doses of Lorazepam IV and morphine IV were calculated for each study day for each patient. Doses were converted to milligrams per kilogram based on the patient's body weight. Higher numbers indicate greater sedation and/or opiate exposure.

Ease of Communication Scale -10-item likert scale total score ranging from 0-40. Each item is 0-4 likert scale, total score is sum of all items with higher scores indicating greater communication difficulty.

The Richmond Agitation Sedation Scale, a 10-level observational rating of agitation-sedation motor activity ranging from +4 'combative' to -5 unresponsive, with 0 as calm. Since this is a categorical measure, we compared proportion of patients with RASS in -1 to +1 (calm) range during study days.

Aim 3 -Delirium/coma-free days is defined as the number of days alive and free of delirium and coma during the 28-day study period. Delirium will be coded as present when a patient displays both features 1 and 2, and either 3 or 4 of the CAM-ICU (Confusion Assessment Method). Coma is defined as a RASS (Richmond Agitation-Sedation Scale ) assessment score of -4 or -5.

(Aim3 )The Family Satisfaction with ICU Care (FS-ICU 24R) questionnaire overall satisfaction score is derived from questions 1 through 24 (26 items) and combines two subscale summary scores. The satisfaction with care summary score is derived from the questions numbered 1 through 14 (which consists of 16 questions because question 2 has parts a, b and c). The satisfaction with decision making summary score is derived from questions 15 through 24 (10 questions). All questions are coded as integers from 1 (worst) to 5 (best). Rescale the summary scores from 1 through 5 to 0 through 100 by subtracting 1 from the scores (so they can range from 0 to 4) and then multiplying each score by 25.

(Aim4) visual analogue touch screen scale via android tablet with REDCap link.

Not able to calculate because the touch screen scale was unreliable. Patients often needed assistance with the touch screen cursor for this experimental measure. We determined that pencil and paper analogue scale was superior for this patient population.

A 24-item survey with lower scores indicating greater satisfaction with care.

(Aim 5) Hospital Anxiety and Depression Scale (HADS) Anxiety sub scale including 7 items each scored from 0-3 with total scores ranging from 0 - 21 with higher scores indicating higher levels of anxiety.

(Aim 5). Hospital Anxiety and Depression Scale (HADS-D)- Depression Subscale including 7 items each scored from 0-3 with total scores ranging from 0 - 21 with higher scores indicating higher levels of depression symptoms.

(Aim 5) Impact of Events Scale-revised. The IES-R is a 22-item self-report instrument with three subscales including intrusion (8 items), avoidance (8 items), and hyperarousal (6 items). The respondent is asked to report the degree of distress experienced for each item in the past 7 days. Each item is scored on a five-point Likert scale (0, not at all; 1, rarely; 2, occasionally; 3, fairly often; and 4, often) and total scores range from 0 to 88. Higher scores are representative of greater distress.

Family Communication Survey administered to participant families. Sum of 9-items with each item rating 0 (not at all) to 4 (extremely difficult), resulting in a total summed score from 0 - 36. Higher scores indicate greater difficulty.

Aims 1 \& 2 - count of the number of errors recorded by video screen capture for each of 8 communication tasks. Individual patients ranged from 0 to 9 errors, however this measure contains no upper range per task as it is a count of actual observed errors committed by patients.

Aims 1 \& 2 - calculated mean of the total number of errors recorded by video screen capture divided by the number of communication tasks completed (8 maximum) Aim 1 extubated patients. Using group 1 and group 2 summary data, 11 patients completed 82 tasks (6 were abandoned, 5 of these by one patient). Removing abandonments, total number of errors = 25/ 82 tasks = 0.30 error rate.

Aim 2 intubated patients. 11 patients completed 69 tasks (18 were abandoned; 1 task was refused). Removing abandonments, total number of errors = 60/ 69 tasks = 0.87error rate.

Aims 1 \& 2 - a single item from the After Scenario Questionnaire (ASQ) of patient's self rating of satisfaction with the "ease of completing" each of 8 communication tasks on the usability test. Question asked of patients was "Overall, I am satisfied with the ease of completing this task". 1-strongly disagree 7-strongly agree. Higher scores indicated greater satisfaction with the ease of completing the task.

Aims 1 \& 2 - This is the time, measured in seconds, on the screen capture recording beginning with the communication task command to patient completion of the communication task or message to patient completion of each of the 8 communication tasks on the usability test, calculated from the screen capture recordings

Aims 1 \& 2. The After-Scenario Questionnaire (ASQ) is a 3-item likert-type scale used to assess how difficult a user perceived a task in a usability test. Responses range from 1-strongly disagree to 7- strongly agree. Total score is the sum of the 3 items, possible scores range from 3 to 21. Higher scores indicated better outcomes.

This was not measured for each task as that was too burdensome for intubated patients. We measured once as an overall rating at the end of the session- 3-item ASQ.

Aims 1 \& 2, System Usability Scale is 13-item likert type scale with item ratings of 1 'strongly agree' to 7 'strongly disagree' to obtain the patient's rating of overall usability of the VidaTalk application, total scores range from 13 to 91

Note: This is different from the standard 10-item SUS that uses a 5-point scale, with scores ranging 0-100.

Measured as a single item : Question asked was - "Presence of communication difficulty in the last few days?" with answers being Yes or No