The Acceptability and Utility of a Tracheostomy Decision-Making Toolkit in a Neuro-ICU

Introduction: Organizational health literacy is the degree to which organizations provide health information that is accessible, understandable, and usable for healthcare decision-making. To address tracheostomy decision-making in the Neuro ICU, we developed a personalized, multimodal health information toolkit (HIT) with the primary objective of assessing its acceptability and utility.


Methods: We conducted a prospective cohort study design to evaluate a HIT for tracheostomy decision-making in a quaternary-care Neuro ICU from November 2024 to April 2025. Eligible healthcare proxies (HCPs) of patients admitted with brain injury were consented and enrolled in the study. Inclusion criteria were HCPs of patients aged 18 and older, who were intubated and undergoing discussions for tracheostomy, and those with English/Spanish language preference. Exclusion criteria included patients with prior tracheostomy or a non-English/Spanish language preference. Once enrolled, HCPs completed demographic surveys and viewed the HIT: a 5-minute video, accompanied by a physical model, written guide, and closed captioning, which was accessible for unlimited views. Utility was measured by the number of HIT views, and acceptability was measured using the Acceptability of Intervention Measure (AIM) survey scores.


Results: A total of 21 HCPs were enrolled in the study. The majority identified as female (57.1%) and White (81%). Most (43%) were aged 45–64, and 19% were aged 65–84. Most participants had at least some college education, with 28.6% reporting “some college, no degree,” and 23.8% held a bachelor’s degree. The majority reported English as their preferred language (85.7%). Across all HCPs, the total number of views was 46, with a mean number of views of 2.2 and a range of 1 to 10 views. AIM survey scores, measured using a 5-point Likert scale, demonstrated high acceptability with a mean total score of 4.5.


Conclusions: Our results demonstrate the acceptability and utility of a multimodal tracheostomy health information toolkit. Future studies are required to study the generalizability of the HIT in other ICU settings where clear communication and OHL are required for goal-concordant care to help families navigate life-sustaining treatment decisions.