Acceptability of older patients' self-assessment in the Emergency Department (ACCEPTED)-a randomised cross-over pilot trial

Abstract

Background: patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown.

Objective: to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers.

Design: randomised crossover pilot study.

Setting: The Hôpital de l'Enfant-Jésus (CHU de Québec-Université Laval) (2018/05-2018/07).

Subjects: (1) ED patients aged ≥65, (2) their caregiver, if present.

Methods: participants' frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data.

Results: sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment.

Conclusions: our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.

Keywords: acceptability; emergency department; older patients; older people; patient reported outcome measures; self-assessment.