A systematic review on voiceless patients' willingness to adopt high-technology augmentative and alternative communication in intensive care units

Intensive Crit Care Nurs. 2021 Apr:63:102948. doi: 10.1016/j.iccn.2020.102948. Epub 2020 Nov 7.


Objective: To systematically evaluate the acceptability of high-technology augmentative and alternative communication (high-tech AAC) among ICU patients who are voiceless guided by the technology acceptance model (TAM).

Methods: We searched the Cochrane Library, EMBASE, PubMed, CINAHL, PsycINFO, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database and Wanfang Database from database inception to September 2019. Studies that examined conscious nonverbal ICU patients with high-tech AAC intervention were included. Two reviewers independently collected and evaluated all the studies. The methodological quality was assessed by using the Joanna Briggs Institute critical appraisal tool.

Results: Eighteen studies with a total of 914 patients met the inclusion criteria, and the quality of the studies varied from low to moderate. Based on the TAM, ICU voiceless patients perceived that high-tech AAC was useful, was easy to use, decreased communication difficulties, reduced negative emotions, and improved symptom identification and management. Patients maintained a positive attitude and were willing to continue to use high-tech AAC.

Conclusions: Although the existing evidence is limited, voiceless patients regard high-tech AAC devices as a useful, reliable, and acceptable alternative communication choice in the ICU. Multicenter, large-sample, and high-quality studies are highly recommended in the future.

Keywords: Communication; High-technology augmentative and alternative communication; Intensive care unit; Mechanical ventilation; Systematic review; Technology acceptance model.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • China
  • Communication
  • Communication Aids for Disabled*
  • Humans
  • Intensive Care Units*
  • Multicenter Studies as Topic
  • Technology