Communication via Patient App for the Nonverbal in the ICU

The study will evaluate communication by nonverbal post-head and neck cancer surgical patients in a crossover design. The participants will use conventional communication devices (e.g., pen & paper) during one 24 hour study period, and an iPad-based app (YoDoc®, Version 2.2) during the 24 hour period. Once the participant is awake and alert post operatively the two study periods occur back to back over 48 hours, the participant is randomised as to which study period they start with (thus varying the initial communication device used). The comparison will be made using a modified QUEST 2.0 survey and an exit survey. At the time of consenting for the study an orientation and training session with the app is undertaken. When the study period commences that utilises the app, re-orientation is performed and app usage data is collected during the 24 hour period. The app is a virtual ICU-specific talkboard with annotated pictograms. Pressing on the pictogram (glass of water, toothbrush, TV remote etc.) results in 'voicing' of the annotation. This may allow a patient to initiate a conversation or request care without the prompting of a health care provider. It also has features which allow for detailed description of pain, as well a blank screen on which words can be written with a stylus. These features allow for the app to be used despite reduced dexterity or muscle power as is common in critically unwell patients. The participant is introduced to the app by a study member (doctor or nurse) following the consenting process. This involves orientation regarding the feature of the app and simulated use with the available accessories (stand, keyboard, stylus) and takes approximately 5 minutes.