Background/Purpose

Medical ethics evolves as health care develops. Digital health technologies are transforming health care delivery and patient and clinician relationships. Ethi­cal approaches are shifting from a clinician focus on beneficence and improving patient health as empha­sized in the Hippocratic oath, to patient-centered models of care, which emphasize patient autonomy in medical decision-making and patients as partners in their care. We have little understanding however, of how digital technologies promote a more patient-centered model of decision-making. Specifically we know little about how clinicians are altering their practices to support patients in making informed choices, and how patients are making treatment decisions. The study aimed to examine the role of various digital technologies in supporting patient choice and informed shared decision-making.

Methods We present preliminary findings of a qualitative interview study, informed by narrative and phenomenology to understand patient and clinicians’ experiences of new technologies and shared decision-making. Eligible participants were: adults with multi-morbidity including arthritis; clinicians with relevant caseloads. Recruitment was via online ads, notices, and word of mouth. The interview guides were consistent for both groups and explored broadly: 1) Use of a range of digital technologies e.g. apps, devices, Internet information, social media; 2) How use influenced illness management and patient-clinician interactions and relationships. An iterative, constant comparative analysis with independent open coding of transcribed data by 2 researchers is ongoing.

Results

We purposively sampled 18 participants for maximum variation (11 patients, 7 clinicians) to take part in 2 in-depth interviews. Three emerging themes have been identified. First, participants described how digital health technologies were changing their roles and responsibilities, involving new types of ‘work’ for both patients and clinicians. Second, patients and clinicians emphasized the benefits of the Internet in preparing patients for discussions in consultations, while identifying the potential burdens of accessing extensive and unreliable sources. Third, mutual trust and respect was integral to effective patient-clinician discussions, sharing online information and informed, shared decision-making.

Conclusion Preliminary findings imply that new technologies support autonomy in terms of informed patient choice and shared decision-making, but only when mutual trust and respect underpin patient-clinician interactions. Understanding how patient-clinician relationships are changing in the era of digital health is critical for ethical, clinical practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/aligning-ethics-with-digital-health-technologies-and-shared-decision-making-interview-accounts-of-patients-and-clinicians/