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Handheld Technology to Improve Patient Care

Evaluating a Support System for Preference-based Care Planning at the Bedside

Affiliation of the author: University of Oslo, Oslo, Norway.

Correspondence and reprints: Cornelia M. Ruland, RN, PhD, Institute of Nursing Science, University of Oslo, Pb 1120 Blindern, 0317 Oslo, Norway; e-mail: <ruland{at}dmi.columbia.edu>.

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.

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