Adapting co-design methodology to a virtual environment: co-designing a communication intervention for adult patients in critical care.

Background: Research co-design is recommended to reduce misalignment between researcher and end-user needs and priorities for healthcare innovation. Engagement of intensive care unit patients, clinicians, and other stakeholders in co-design has historically relied upon face-to-face meetings. Here, we report on our co-design processes for the development of a bundled intensive care unit patient communication intervention that used exclusively virtual meeting methods in response to COVID-19 pandemic social distancing restrictions. Methods: We conducted a series of virtual co-design sessions with a committee of stakeholder participants recruited from a medical-surgical intensive care unit of a community teaching hospital in Toronto, Canada. Published recommendations for co-design methods were used with exclusively virtual adaptations to improve ease of stakeholder participation as well as the quality and consistency of co-design project set-up, facilitation, and evaluation. Virtual adaptations included the use of email for distributing information, videos, and electronic evaluations as well as the use of a videoconferencing platform for synchronous meetings. We used a flexible meeting plan including asynchronous virtual methods to reduce attendance barriers for time-constrained participants. Results: Co-design participants included a patient and a family member (n = 2) and professionally diverse healthcare providers (n = 9), plus a facilitator. Overall, participants were engaged and reported a positive experience with the virtually adapted co-design process. Reported benefits included incorporation of diverse viewpoints in the communication intervention design and implementation plan. Challenges related to lack of hands-on time during development of the co-designed intervention and participant availability to meet regularly albeit virtually. Conclusions: This report describes the methods, benefits, and challenges of adapting in-person co-design methods to a virtual environment to produce a bundled communication intervention for use in the adult intensive care unit during the COVID-19 pandemic. Adapting recommended co-design methods to a virtual environment can provide further opportunities for stakeholder participation in intervention design. Plain English summary: Background: Modifications to co-design methods were necessary during pandemic conditions but can also be useful when needing to overcome geographic and time restrictions or operating with limited resources. This report describes virtual adaptations made during the co-design of a communication intervention for patients requiring critical care. Modifications included use of a video platform for meetings, email correspondence and flexible meeting approach. Methods: Together with a critical care patient, family, and healthcare providers we developed a communication intervention and made virtual modifications to recommended co-design methods. Results: Overall, participants were engaged and described having a positive experience with the co-design process. This design also had some limitations including ongoing challenges with time availability for busy clinician participants. Conclusions: This paper may be useful for those seeking to use virtual co-design methods for intervention development and health research. [ABSTRACT FROM AUTHOR]