Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project

Shaw, Sara; Cameron, Deborah; Wherton, Joseph; Seuren, Lucas M.; Vijayaraghavan, Shanti; Bhattacharya, Satya; A’Court, Christine; Morris, Joanne; Greenhalgh, Trisha

doi:10.2196/10913

Cited by 13 publications

(9 citation statements)

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“…We conducted secondary analysis of data that were collected between 2015 and 2018 in two separate studies on video-mediated consultations Shaw et al, 2018 . The consultations were recorded in (antenatal) diabetes, cancer, and heart failure services in the UK, and were conducted using either consumer Skype or FaceTime.…”

Section: Methodsmentioning

confidence: 99%

Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction

Seuren

Wherton

Greenhalgh

et al. 2021

Journal of Pragmatics

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Section: Methodsmentioning

confidence: 99%

Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction

Seuren

Wherton

Greenhalgh

et al. 2021

Journal of Pragmatics

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“…This paper forms part of the Qualitative Analysis of Remote Consultations study, focused on identifying the communication strategies that make up a good video consultation (see protocol for details [21]). Our focus here is on seven video consultations (using FaceTime) between heart failure specialist nurses in Oxford and community-based patients having routine heart failure reviews, including physical examinations (typically measuring weight, blood pressure, heart rate, and rhythm [using a blood pressure monitor put on by the patient or relative and incorporating irregular heartbeat indicator to assess for atrial fibrillation] and oxygen saturation; assessing edema in ankles and legs; and performing chest auscultation for signs of fluid overload or infection).…”

Section: Methodsmentioning

confidence: 99%

Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis

et al. 2020

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Background Video consultations are increasingly seen as a possible replacement for face-to-face consultations. Direct physical examination of the patient is impossible; however, a limited examination may be undertaken via video (eg, using visual signals or asking a patient to press their lower legs and assess fluid retention). Little is currently known about what such video examinations involve. Objective This study aimed to explore the opportunities and challenges of remote physical examination of patients with heart failure using video-mediated communication technology. Methods We conducted a microanalysis of video examinations using conversation analysis (CA), an established approach for studying the details of communication and interaction. In all, seven video consultations (using FaceTime) between patients with heart failure and their community-based specialist nurses were video recorded with consent. We used CA to identify the challenges of remote physical examination over video and the verbal and nonverbal communication strategies used to address them. Results Apart from a general visual overview, remote physical examination in patients with heart failure was restricted to assessing fluid retention (by the patient or relative feeling for leg edema), blood pressure with pulse rate and rhythm (using a self-inflating blood pressure monitor incorporating an irregular heartbeat indicator and put on by the patient or relative), and oxygen saturation (using a finger clip device). In all seven cases, one or more of these examinations were accomplished via video, generating accurate biometric data for assessment by the clinician. However, video examinations proved challenging for all involved. Participants (patients, clinicians, and, sometimes, relatives) needed to collaboratively negotiate three recurrent challenges: (1) adequate design of instructions to guide video examinations (with nurses required to explain tasks using lay language and to check instructions were followed), (2) accommodation of the patient’s desire for autonomy (on the part of nurses and relatives) in light of opportunities for involvement in their own physical assessment, and (3) doing the physical examination while simultaneously making it visible to the nurse (with patients and relatives needing adequate technological knowledge to operate a device and make the examination visible to the nurse as well as basic biomedical knowledge to follow nurses’ instructions). Nurses remained responsible for making a clinical judgment of the adequacy of the examination and the trustworthiness of the data. In sum, despite significant challenges, selected participants in heart failure consultations managed to successfully complete video examinations. Conclusions Video examinations are possible in the context of heart failure services. However, they are limited, time consuming, and challenging for all involved. Guidance and training are needed to support rollout of this new service model, along with research to understand if the challenges identified are relevant to different patients and conditions and how they can be successfully negotiated.

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“…We have previously published a detailed study protocol [10]. This section provides a summary along with an update on the analytic approach.…”

Section: Methodsmentioning

confidence: 99%

“…As set out in the QuARC study protocol [10], the aims of the study were to identify and analyze the communication strategies through which remote consultations are accomplished and to produce guidance for patients and clinicians to improve the communicative quality of video consultations. Specifically, our objectives were (1) to conduct a secondary analysis of a multimodal dataset of 37 remote consultations with diabetes, antenatal diabetes, cancer, and heart failure patients and their clinicians using a combination of ethnographic and microanalytic approaches to investigate how interaction is affected by mediation via Skype or similar apps and (2) develop guidance for patients and clinicians in conducting remote consultations.…”

Section: Aims Objectives and Research Questionsmentioning

confidence: 99%

“…Published research on video outpatient consultations has been summarized in several recent reviews [7][8][9][10]. These show great potential for video consultations in terms of acceptability, safety, and effectiveness in patients considered clinically eligible across a range of conditions, such as diabetes [11][12][13][14][15], ophthalmology [16], cancer [17,18], chronic kidney disease [19], spinal cord injury [6,20,21], chronic obstructive pulmonary disease [22,23], mental health conditions [24,25], Down syndrome [26], cerebral palsy [27], chronic pain [18,28,29], therapies (eg, speech and language therapy [30][31][32]), support after premature birth [33], support of patients in care homes [34], and plastic surgery [35].…”

Section: Introductionmentioning

confidence: 99%

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Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction (Preprint)

Shaw¹,

Seuren²,

Wherton³

et al. 2020

Preprint

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BACKGROUND Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. OBJECTIVE Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. METHODS We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). RESULTS Patients had been selected by their clinician as <i>appropriate</i> for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. CONCLUSIONS A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. INTERNATIONAL REGISTERED REPORT RR2-10.2196/10913

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Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project

Cited by 13 publications

References 76 publications

Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction

Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction

Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis

Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction (Preprint)

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