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Ford J, Reuber M. Comparisons of Communication in Medical Face-To-Face and Teleconsultations: A Systematic Review and Narrative Synthesis. HEALTH COMMUNICATION 2024; 39:1012-1026. [PMID: 37092952 DOI: 10.1080/10410236.2023.2201733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The COVID-19 pandemic has brought telemedicine into mainstream medical practice (although questions remain over its role in a post-pandemic world). Research suggests that most patients and providers are satisfied with the flexibility and convenience of teleconsultations. However, there is continuing uncertainty about whether this shift has a clinically relevant impact on the quality of doctor-patient interaction. We conducted a systematic search of studies comparing communication in medical face-to-face consultations and teleconsultations. We included only studies which examined communication directly using recordings, excluding studies which used questionnaires or interviews. Studies were appraised using modified versions of the Critical Appraisal Skills Programme (CASP) checklists. Our search yielded 25,348 records, of which 22 were included in the final review. These studies were conducted in various medical specialties. Methodologies included approaches based on quantified communication behaviors using coding systems and qualitative studies using microanalytic methods. Except for duration (where there was evidence of face-to-face consultations being longer), no differences between the two modes of communication were consistently identified. In the aggregate, however, statistically significant differences were more prominent in primary care and more likely to favor face-to-face consultations. Qualitative studies also highlighted differences in how communication behaviors were manifested in each modality. Because much of the examined research was conducted in selected or non-routine settings, its applicability to the less selective use of telemedicine during and after the pandemic is limited.
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Affiliation(s)
- Joseph Ford
- Department of Neuroscience, University of Sheffield, Broomhall, Sheffield, UK
| | - Markus Reuber
- Department of Neuroscience, University of Sheffield, Broomhall, Sheffield, UK
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Seuren LM, Ilomäki S, Dalmaijer E, Shaw SE, Stommel WJP. Communication in Telehealth: A State-of-the-Art Literature Review of Conversation-Analytic Research. RESEARCH ON LANGUAGE AND SOCIAL INTERACTION 2024; 57:73-90. [PMID: 38741749 PMCID: PMC11090155 DOI: 10.1080/08351813.2024.2305045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
We provide a state-of-the-art review of research on conversation analysis and telehealth. We conducted a systematic review of the literature, focusing on studies that investigate how technology is procedurally consequential for the interaction. We discerned three key topics: the interactional organization, the therapeutic relationship, and the clinical activities of the encounter. The literature on telehealth is highly heterogeneous, with significant differences between text-based care (e.g., via chat or e-mail) and audio(visual) care (e.g., via telephone or video). We discuss the extent to which remote care can be regarded as a demarcated field for study or whether the medium is merely part of the "context," particularly when investigating hybrid and polymedia forms of care involving multiple technological media.
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Affiliation(s)
- Lucas M. Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- Institute for Better Health, Trillium Health Partners, Canada
| | | | - Evi Dalmaijer
- Centre for Language Studies, Radboud University, Netherlands
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Devagiri B, Ariyasena ADK, Siriwardhana DD, Sumanasena S. Telehealth services for children with neuro-developmental disabilities in the Asia-Pacific region: A systematic review. Child Care Health Dev 2024; 50:e13192. [PMID: 38049949 DOI: 10.1111/cch.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/14/2023] [Accepted: 10/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND In recent years telehealth became a popular and a rational health service delivery approach, especially amidst multiple challenges posed while providing health care interventions during the COVID-19 pandemic. AIM We synthesized available evidence on telehealth for managing children with NDDs in the Asia-Pacific region with the aim of identifying successful methods. METHODOLOGY We systematically reviewed six electronic databases: MEDLINE, AMED, EMBASE, PsychInfo, Web of Science, and (CINAHL plus) using the keywords and database-specific subject headings from their inception to 25th August 2021. Review findings were synthesized narratively, and harvest plots were used to demonstrate the effect of interventions. The protocol and reporting the findings of this review adhered to PRISMA 2020 guidelines. PROSPERO registration: CRD 340690. RESULTS We harvested 30,823 records; 17,563 duplicates were removed, and 196 full-text articles were assessed for eligibility. 16 studies with multiple research designs were included in the review. Eight were from the Pacific region and eight represented Asia. The interventions targeted families and children with a variety of NDDs (autism spectrum disorder, Down syndrome, cleft lip and palate, hearing impairment, cerebral palsy etc.) via telehealth. Telehealth packages consisted of direct and indirect methods of synchronous, asynchronous, and hybrid approaches. All studies used parent-led intervention strategies. Telehealth reported a positive effect in 7/16 studies while five showed a neutral effect. CONCLUSIONS According to published evidence telehealth for children with NDDs is an evolving, evidence-based service facilitation modality in the Asia-Pacific region, with only a few published randomized controlled trials. The systematic review shows promising telehealth practices emerging across the region despite the diversity in NDDs studied.
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Affiliation(s)
- Bhagya Devagiri
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Ayati, National Centre for Children with Disabilities, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | | | - Dhammika Deepani Siriwardhana
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Samanmali Sumanasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Ayati, National Centre for Children with Disabilities, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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Hatherly K, Glista D, Testani D, Brunton L, Cunningham BJ. A scoping review of virtual synchronous intervention studies in preschool rehabilitation. Disabil Rehabil 2024; 46:232-240. [PMID: 36546349 DOI: 10.1080/09638288.2022.2157054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention. METHODS Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries. RESULTS Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement. CONCLUSION This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions.
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Affiliation(s)
- Kathryn Hatherly
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
| | - Danielle Glista
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
- National Centre for Audiology, Elborn College, Western University, London, Canada
| | - Daniela Testani
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Laura Brunton
- School of Physical Therapy, Elborn College, Western University, London, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Barbara Jane Cunningham
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
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Retamal-Walter F, Waite M, Scarinci N. Exploring engagement in telepractice early intervention for young children with developmental disability and their families: a qualitative systematic review. Disabil Rehabil Assist Technol 2023; 18:1508-1521. [PMID: 35287526 DOI: 10.1080/17483107.2022.2048098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This review aimed to (1) describe the nature of engagement in telepractice early intervention (EI) for families of young children with developmental disabilities; and (2) identify major barriers and facilitators for developing and maintaining engagement via telepractice. METHODS A qualitative systematic review was conducted, searching systematically across six databases (i.e., PUBMED, CINAHL, PsycINFO, Web of Science, EMBASE, and Scopus). The search identified 14 studies which met the inclusion criteria of peer-reviewed studies exploring EI professionals', families', managers', or service's views of engagement in telepractice EI using qualitative methodologies. The studies were appraised using the Critical Appraisal Skills Programme and data were analysed using thematic synthesis. RESULTS The synthesised data were grouped into four main themes reflecting the nuances of engagement in telepractice EI: (1) children and family engagement is facilitated and enhanced during telepractice interaction; (2) engagement may enhance therapy outcomes through telepractice multidisciplinary collaboration and communication; (3) there are challenges to engagement in the telepractice environment; and (4) preparation in telepractice can improve the development of engagement. CONCLUSION This review provides a comprehensive characterisation of engagement and describes a set of conceptual recommendations for establishing and maintaining engagement when using telepractice in EI.IMPLICATIONS FOR REHABILITATIONBuilding and maintaining engagement with families of young children with developmental disability/delay through telepractice is feasible.Despite some similarities between in-person and telepractice engagement, there are certain unique features of telepractice engagement that professionals and families may need to consider while providing/receiving early intervention services remotely.Preparation and training on how to engage in telepractice is recommended for professionals and families of young children with developmental disability/delay.Understanding how professionals and families engage with one another during telepractice interactions may improve targeted child and family intervention outcomes.
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Affiliation(s)
- Felipe Retamal-Walter
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Monique Waite
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Gauhe G, Cisneros REK, Ward J, Hohenschurz-Schmidt DJ. Creatively Adapting Touch-Based Practices to the Web Format During the COVID-19 Pandemic: Systematic Review. J Med Internet Res 2023; 25:e46355. [PMID: 37883151 PMCID: PMC10636621 DOI: 10.2196/46355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/11/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced numerous touch-based fields, including manual therapy, body psychotherapy, arts therapy, creative arts practices, and the fitness industry, to swiftly transition to web-based service delivery. These disciplines faced substantial challenges in adapting their traditionally in-person practices, which rely heavily on physical touch and close proximity, to a web format. OBJECTIVE This review intends to provide a systematically sourced overview of the literature concerning innovative approaches for adapting touch-based practices to the web format in response to the COVID-19 pandemic. METHODS A systematic search across 7 databases and gray literature sources identified studies presenting innovative web delivery methods, particularly those addressing the challenges arising from the absence of physical proximity and touch. The inclusion criteria were designed to encompass studies exploring the creative adaptation of touch-based practices to web formats in response to the COVID-19 pandemic irrespective of study methodology. The exclusion criteria applied to studies focusing solely on technical aspects of web delivery or nontouch or noninteractive practices. There were no geographical restrictions, but the selection was limited to publications from 2020 onward. As only qualitative studies were found, data synthesis was conducted thematically. RESULTS The review encompassed 17 studies revealing that touch-based fields successfully devised innovative and creative methods for web service delivery. These methods were categorized into five main themes: (1) adapted working methods (cross-field methods), (2) adapted working methods for sensorial experiences and nonphysical connections, (3) creative methods using materials or additional tools, (4) creative use of web-based platform tools or additional technologies, and (5) creative methods requiring previous preparation of practitioners or participants. These creative approaches allowed practitioners to address the challenges of web touch-based practices, fostering connections and offering unique sensory experiences, albeit with some concerns related to technology and preparation. CONCLUSIONS These innovative methods demonstrate promise in circumventing the limitations imposed by the lack of physical touch and proximity in web settings during the COVID-19 pandemic. Furthermore, these insights hold potential for application in other fields in the future. This systematic search and thematic synthesis provide valuable guidance for practitioners and educators seeking to navigate the evolving landscape of web service delivery in touch-based disciplines, ensuring continuity of care even in challenging circumstances. TRIAL REGISTRATION PROSPERO CRD42022379731; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379731.
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Affiliation(s)
- Greta Gauhe
- Centre for Dance Research, Coventry University, Coventry, United Kingdom
| | | | - Jade Ward
- Centre for Dance Research, Coventry University, Coventry, United Kingdom
| | - David J Hohenschurz-Schmidt
- Pain Group, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Research Department, University College of Osteopathy, London, United Kingdom
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Grant C, Jones A, Land H. What are the perspectives of speech pathologists, occupational therapists and physiotherapists on using telehealth videoconferencing for service delivery to children with developmental delays? A systematic review of the literature. Aust J Rural Health 2022; 30:321-336. [PMID: 35157335 PMCID: PMC9303186 DOI: 10.1111/ajr.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
Objective To identify the attitudes and perspectives of speech pathologists, occupational therapists and physiotherapists on using telehealth videoconferencing for service delivery to children with developmental delays. Design Systematic Literature Review. Method An electronic search of databases Scopus, CINAHL, MEDLINE, PEDro, Speechbite, OTseeker and ScienceDirect was undertaken in October 2020. Articles were compared with eligibility criteria by 2 authors. All articles were appraised for quality and level of evidence. Findings Fourteen studies were deemed to be eligible. Results were synthesised using a narrative analysis. The themes identified were technology, self‐efficacy, replacement of face‐to‐face services, time management, relationships, access and family‐centred care. Each of these themes was seen as both a potential barrier and a facilitator when trying to provide services via telehealth. Conclusions The results in this review cannot be generalised due to small sampling size, low response rates, lack of maximum variation sampling and under‐representation of occupational therapists and physiotherapists. Study design was either mixed‐methods survey or interview or only survey or interview. Risk of bias in studies was high. Further research is required including comparison studies and cost‐benefit analysis.
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Affiliation(s)
- Claire Grant
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anne Jones
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Helen Land
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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Shaw SE, Hughes G, Wherton J, Moore L, Rosen R, Papoutsi C, Rushforth A, Morris J, Wood GW, Faulkner S, Greenhalgh T. Achieving Spread, Scale Up and Sustainability of Video Consulting Services During the COVID-19 Pandemic? Findings From a Comparative Case Study of Policy Implementation in England, Wales, Scotland and Northern Ireland. Front Digit Health 2021; 3:754319. [PMID: 34988546 PMCID: PMC8720935 DOI: 10.3389/fdgth.2021.754319] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Requirements for physical distancing as a result of COVID-19 and the need to reduce the risk of infection prompted policy supporting rapid roll out of video consulting across the four nations of the UK-England, Northern Ireland, Scotland and Wales. Drawing on three studies of the accelerated implementation and uptake of video consulting across the four nations, we present a comparative and interpretive policy analysis of the spread and scale-up of video consulting during the pandemic. Data include interviews with 59 national level stakeholders, 55 health and social care staff and 30 patients, 20 national documents, responses to a UK-wide survey of NHS staff and analysis of routine activity data. Sampling ensured variations in geography, clinical context and adoption progress across the combined dataset. Comparative analysis was guided by theory on policy implementation and crisis management. The pandemic provided a "burning platform" prompting UK-wide policy supporting the use of video consulting in health care as a critical means of managing the risk of infection and a standard mode of provision. This policy push facilitated interest in video consulting across the UK. There was, however, marked variation in how this was put into practice across the four nations. Pre-existing infrastructure, policies and incentives for video consulting in Scotland, combined with a collaborative system-level approach, a program dedicated to developing video-based services and resourcing and supporting staff to deliver them enabled widespread buy-in and rapid spread. In England, Wales and Northern Ireland, pre-existing support for digital health (e.g., hardware, incentives) and virtual care, combined with reduced regulation and "light touch" procurement managed to override some (but by no means all) cultural barriers and professional resistance to implementing digital change. In Northern Ireland and Wales, limited infrastructure muted spread. In all three countries, significant effort at system level to develop, review and run video consulting programs enabled a substantial number of providers to change their practice, albeit variably across settings. Across all four nations ongoing uncertainty, potential restructuring and tightening of regulations, along with difficulties inherent in addressing inequalities in digital access, raise questions about the longer-term sustainability of changes to-date.
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Affiliation(s)
- Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joanne Morris
- Joint Research Management Office, Barts Health NHS Trust, London, United Kingdom
| | - Gary W. Wood
- Independent Research Consultant, Birmingham, United Kingdom
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Claridge R, Kroll N. Aural Rehabilitation via Telepractice During COVID-19: A Global Perspective on Evolving Early Intervention Practices. Int J Telerehabil 2021; 13:e6362. [PMID: 34345339 PMCID: PMC8287731 DOI: 10.5195/ijt.2021.6362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pre-pandemic, telepractice was not globally implemented despite its effectiveness. Clinicians reported challenges related to technology, confidence, and inadequate resources. OBJECTIVES To document global telepractice, identify current obstacles and measure the impact of a possible solution. The timing of this research facilitated tracking telepractice changes during the pandemic. METHODS Two surveys measured practitioners' experience and attitude towards telepractice. Survey 1 was completed in February-March 2020. Participants then received two specialized lesson kits to trial if desired. Survey 2 was a follow-up after 4-6 weeks. RESULTS Between surveys, the proportion of participants providing telepractice increased from 47.6% to 91.7%. The lesson kits were trialled by 74.3%. Their use had a positive impact on three of the top five factors affecting the delivery of telepractice: parent coaching, clinician experience and accessing resources. Conclusion: Telepractice was rapidly adopted globally during the pandemic. The specialized resources were helpful in overcoming some of the barriers to delivery.
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Morrison C, Beattie M, Wherton J, Stark C, Anderson J, Hunter-Rowe C, Gray NM. Testing and implementing video consulting for outpatient appointments: using quality improvement system thinking and codesign principles. BMJ Open Qual 2021; 10:bmjoq-2020-001259. [PMID: 33674346 PMCID: PMC7939006 DOI: 10.1136/bmjoq-2020-001259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of attending hospital OPAs due to transport difficulties, cost, poor health, caring and work responsibilities. Digital solutions may help ameliorate these challenges. This project aimed to implement codesigned outpatient video consultations across National Health Service (NHS) Highland using system-wide quality improvement approaches to implementation, involving patients, carers, clinical and non-clinical staff, national and local strategic leads. System mapping; an intensive codesign process involving extensive stakeholder engagement and real-time testing; Plan, Do, Study, Act cycles; and collection of clinician and patient feedback were used to optimise the service. Standardised processes were developed and implemented, which made video consulting easy to use for patients, embedded video into routine health service systems for clinicians and non-clinical staff, and automated much of the administrative burden. All clinicians and staff are using the system and both groups identified benefits in terms of travel time and costs saved. Transferable lessons for other services are identified, providing a practical blueprint for others to adapt and use in their own contexts to help implement and sustain video consultation services now and in the future.
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Affiliation(s)
| | - Michelle Beattie
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Heal, University of Oxford, Oxford, UK
| | - Cameron Stark
- Consultant in Public Health Medicine, Department of Public Health, NHS Highland, Inverness, Scotland.,Honorary Reader & Lecturer Pg Cert Healthcare Quality Improvement, Lews Castle College, University of the Highlands and Islands, Stornoway, Scotland
| | | | - Carolyn Hunter-Rowe
- Highland Alcohol and Drugs Partnership, NHS Highland, Inverness, Highland, UK
| | - Nicola M Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School of Health Sciences, University of Dundee, Dundee, UK
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Seuren LM, Wherton J, Greenhalgh T, Shaw SE. Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction. JOURNAL OF PRAGMATICS 2021; 172:63-78. [PMID: 33519050 PMCID: PMC7819463 DOI: 10.1016/j.pragma.2020.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Latency in video-mediated interaction can frustrate smooth turn-taking: it may cause participants to perceive silence at points where talk should occur, it may cause them to talk in overlap, and it impedes their ability to return to one-speaker-at-a-time. Whilst potentially frustrating for participants, this makes video-mediated interaction a perspicuous setting for the study of social interaction: it is an environment that nurtures the occurrence of turn-taking problems. For this paper, we conducted secondary analysis of 25 video consultations recorded for heart failure, (antenatal) diabetes, and cancer services in the UK. By comparing video recordings of the patient's and clinician's side of the call, we provide a detailed analysis of how latency interferes with the turn-taking system, how participants understand problems, and how they address them. We conclude that in our data latency unnoticed until it becomes problematic: participants act as if they share the same reality.
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Affiliation(s)
- Lucas M. Seuren
- Corresponding author. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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12
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Shaw SE, Seuren LM, Wherton J, Cameron D, A'Court C, Vijayaraghavan S, Morris J, Bhattacharya S, Greenhalgh T. Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction. J Med Internet Res 2020; 22:e18378. [PMID: 32391799 PMCID: PMC7248806 DOI: 10.2196/18378] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/15/2023] Open
Abstract
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 appropriate 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 IDENTIFIER (IRRID) RR2-10.2196/10913.
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Affiliation(s)
- Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lucas Martinus Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Deborah Cameron
- Faculty of Linguistics, University of Oxford, Oxford, United Kingdom
| | - Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Seuren LM, Wherton J, Greenhalgh T, Cameron D, A'Court C, Shaw SE. Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis. J Med Internet Res 2020; 22:e16694. [PMID: 32130133 PMCID: PMC7059096 DOI: 10.2196/16694] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
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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Affiliation(s)
- Lucas Martinus Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Deborah Cameron
- Faculty of Linguistics, University of Oxford, Oxford, United Kingdom
| | - Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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