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. 2022 Jul 21;22(1):198.
doi: 10.1186/s12874-022-01653-2.

Development of a factorial survey for use in an international study examining clinicians' likelihood to support the decision to initiate invasive long-term ventilation for a child (the TechChild study)

Mary Brigid Quirke  1 , Denise Alexander  1 , Kate Masterson  1 , Jo Greene  1 , Cathal Walsh  2 , Piet Leroy  3 , Jay Berry  4 , Lee Polikoff  5 , Maria Brenner  6
Affiliations

Development of a factorial survey for use in an international study examining clinicians' likelihood to support the decision to initiate invasive long-term ventilation for a child (the TechChild study)

Mary Brigid Quirke et al. BMC Med Res Methodol. .

Abstract

Background: The decision to initiate invasive long-term ventilation for a child with complex medical needs can be extremely challenging. TechChild is a research programme that aims to explore the liminal space between initial consideration of such technology dependence and the final decision. This paper presents a best practice example of the development of a unique use of the factorial survey method to identify the main influencing factors in this critical juncture in a child's care.

Methods: We developed a within-subjects design factorial survey. In phase 1 (design) we defined the survey goal (dependent variable, mode and sample). We defined and constructed the factors and factor levels (independent variables) using previous qualitative research and existing scientific literature. We further refined these factors based on expert feedback from expert clinicians and a statistician. In phase two (pretesting), we subjected the survey tool to several iterations (cognitive interviewing, face validity testing, statistical review, usability testing). In phase three (piloting) testing focused on feasibility testing with members of the target population (n = 18). Ethical approval was obtained from the then host institution's Health Sciences Ethics Committee.

Results: Initial refinement of factors was guided by literature and interviews with clinicians and grouped into four broad categories: Clinical, Child and Family, Organisational, and Professional characteristics. Extensive iterative consultations with clinical and statistical experts, including analysis of cognitive interviews, identified best practice in terms of appropriate: inclusion and order of clinical content; cognitive load and number of factors; as well as language used to suit an international audience. The pilot study confirmed feasibility of the survey. The final survey comprised a 43-item online tool including two age-based sets of clinical vignettes, eight of which were randomly presented to each participant from a total vignette population of 480.

Conclusions: This paper clearly explains the processes involved in the development of a factorial survey for the online environment that is internationally appropriate, relevant, and useful to research an increasingly important subject in modern healthcare. This paper provides a framework for researchers to apply a factorial survey approach in wider health research, making this underutilised approach more accessible to a wider audience.

Keywords: Chronically critically ill child; Factorial survey; Long-term ventilation; Paediatric complex care; Pretesting; Survey design; Technology dependence; Validity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of basic components of a factorial survey
Fig. 2
Fig. 2
Factorial survey development in the TechChild research programme (2021)
See this image and copyright information in PMC

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References

    1. Burns J, Sellers D, Meyer E, Lewis-Newby M, Truog R. Epidemiology of death in the PICU at five U.S. teaching hospitals. Crit Care Med. 2014;9(42):8. - PMC - PubMed
    1. Matsumoto N, Hatachi T, Inata Y, Shimizu Y, M T. Long-term mortality and functional outcome after prolonged paediatric intensive care unit stay. Eur J Pediatr. 2019;178:6. - PubMed
    1. Moynihan K, Alexander P, Schlapbach L, Millar J, Jacobe S, Ravindranathan H, et al. Epidemiology of childhood death in Australian and New Zealand intensive care units. Intensive Care Med. 2019;45:10. - PubMed
    1. Pavone M, Verrillo E, Onofri A, Caggiano S, Chiarini Testa MB, Cutrera R. Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome. Ital J Pediatr. 2020;46(1):12. - PMC - PubMed
    1. Pollack M, Banks R, Holubkov R, Meert K. Long-term outcome of PICU patients discharged with new, functional status morbidity. Pediatr Crit Care Med. 2021;22(1):27–39. - PMC - PubMed

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