Clinician behaviors in telehealth care delivery: a systematic review

Abstract

Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.

COVID-19 issues related to pediatric neuropsychology and inpatient rehabilitation – challenges to usual care and solutions during the pandemic

“…Like all providers, inpatient neuropsychologists recognize the need to maintain safety while providing the necessary care and have adopted dynamic models of care that include a range of in-person, telehealth, and hybrid models depending in part on the institution, state, and local guidelines.Like outpatient providers, inpatient neuropsychologists contend with challenges related to test validity, technology, and economic disparities, as well as state laws, and legal and financial considerations for telehealth (Brophy, 2017;Olson et al, 2018). In addition, there are inherent challenges related to rapport building which may be exacerbated as clinicians rely more on telehealth than ever before (Agha et al, 2009;Henry et al, 2017;Rothwell et al, 2012).…”

Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition

“…Henry and colleagues [11] recently systematically evaluated a set of 45 studies worldwide relating to healthcare provider behaviors, perceptions and concerns in regard to telehealth care delivery from a qualitative perspective. While the authors believed they could not yet present a set of best practices for clinician behaviors in regard to telehealth care delivery, they emphasized the following emerging themes as important considerations to improving provider education, as well as the quality of care, to support optimal utilization of telehealth, including: "Perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse; reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery" [11].…”

Improving Telehealth Knowledge in Nurse Practitioner Training for Rural and Underserved Populations

“…Student learning outcomes for telehealth education in advanced practice nursing have not been reported in the literature; however, interpersonal behavioral outcomes for provider training and attributes of care in telehealth delivery have been examined. Henry, Block, Ciesla, McGowan, and Vozenilek (2017) explored communication skills, professionalism, and "telepresence" in a qualitative systematic review of the literature. Six themes were identified as considerations for practice and education.…”

“…Six themes were identified as considerations for practice and education. These included perceptions of the utility of telehealth, differences in communication patterns (e.g., pace and type of discourse), reliance on visual cues in communicating empathy and building rapport, and confidentiality and privacy in telehealth care delivery (Henry et al, 2017). These attributes provide a basis for the establishment of student learning outcomes in a classroom setting.…”

“…Bandura (1977) described self-efficacy as a student's confidence in his or her ability to perform a task. Previous research suggests that a lack of confidence in telehealth and associated technology is a potential barrier to its use (Browning, Tullai-McGuinness, Madigan, & Struk, 2009;Buckley, Tran, & Prandoni, 2004;Courtney-Pratt et al, 2012;Demiris, Edison, & Vijaykumar, 2005;Ford, Avey, Deruyter, Whipple, & Rivkin, 2012;Henry et al, 2017). The intervention in this study included a presentation designed to increase knowledge of telehealth as a tool for delivery of health care services.…”