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Grosman-Rimon L, Wegier P. With advancement in health technology comes great responsibility - Ethical and safety considerations for using digital health technology: A narrative review. Medicine (Baltimore) 2024; 103:e39136. [PMID: 39151529 PMCID: PMC11332755 DOI: 10.1097/md.0000000000039136] [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: 03/06/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 08/19/2024] Open
Abstract
The accelerated adoption of digital health technologies in the last decades has raised important ethical and safety concerns. Despite the potency and usefulness of digital health technologies, addressing safety, and ethical considerations needs to take greater prominence. This review paper focuses on ethical and safety facets, including health technology-related risks, users' safety and well-being risks, security and privacy concerns, and risks to transparency and diminished accountability associated with the utilization of digital health technologies. In order to maximize the potential of health technology benefits, awareness of safety risks, and ethical concerns should be increased, and the use of appropriate strategies and measures should be considered.
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Affiliation(s)
- Liza Grosman-Rimon
- Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
- Research Institute, Humber River Health, Toronto, ON, Canada
| | - Pete Wegier
- Research Institute, Humber River Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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2
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Ursin F, Müller R, Funer F, Liedtke W, Renz D, Wiertz S, Ranisch R. Non-empirical methods for ethics research on digital technologies in medicine, health care and public health: a systematic journal review. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024:10.1007/s11019-024-10222-x. [PMID: 39120780 DOI: 10.1007/s11019-024-10222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 08/10/2024]
Abstract
Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the "empirical turn" in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the increased use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health.
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Affiliation(s)
- Frank Ursin
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Regina Müller
- Institute of Philosophy, University of Bremen, Enrique-Schmidt-Straße 7, 28359, Bremen, Germany
| | - Florian Funer
- Institute for Ethics and History of Medicine, Eberhard Karls University, Gartenstrasse 47, 72074, Tübingen, Tübingen, Germany
| | - Wenke Liedtke
- Faculty of Theology, University of Greifswald, Am Rubenowplatz 2-3, 17489, Greifswald, Germany
| | - David Renz
- Faculty of Protestant Theology, University of Bonn, Am Hofgarten 8, 53113, Bonn, Germany
| | - Svenja Wiertz
- Department of Medical Ethics and the History of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Robert Ranisch
- Junior Professorship for Medical Ethics with a Focus on Digitization, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, 14476, Potsdam, Golm, Germany
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3
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Silva GS, Andrade JBCD. Digital health in stroke: a narrative review. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-10. [PMID: 39187259 DOI: 10.1055/s-0044-1789201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Digital health is significantly transforming stroke care, particularly in remote and economically diverse regions, by harnessing mobile and wireless technologies, big data, and artificial intelligence (AI). Despite the promising advancements, a notable gap exists in the formal clinical validation of many digital health applications, raising concerns about their efficacy and safety in real-world clinical settings. Our review systematically explores the landscape of digital health in stroke care, assessing the development, validation, and implementation of various digital tools. We adopted a comprehensive search strategy, scrutinizing peer-reviewed articles published between January 2015 and January 2024, to gather evidence on the effectiveness of digital health interventions. A rigorous quality assessment was conducted to ensure the reliability of the included studies, with findings synthesized to underscore key technological innovations and their clinical outcomes. Ethical considerations were meticulously observed to maintain data confidentiality and integrity. Our findings highlight the transformative potential of mobile health technologies, AI, and telemedicine in improving diagnostic accuracy, treatment efficacy, and patient outcomes in stroke care. Our paper delves into the evolution and impact of digital health in cerebrovascular prevention, diagnosis, rehabilitation and stroke treatment, emphasizing the digital health's role in enhancing access to expert care, mitigating treatment delays and improving outcomes. However, the review also underscores the critical need for rigorous clinical validation and ethical considerations in the development and deployment of digital health technologies to ensure their safe and effective integration into stroke care practices.
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Affiliation(s)
- Gisele Sampaio Silva
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, Organização de Pesquisa Acadêmica, São Paulo SP, Brazil
| | - João Brainer Clares de Andrade
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, Organização de Pesquisa Acadêmica, São Paulo SP, Brazil
- Instituto Tecnológico de Aeronáutica, Laboratório de Bioengenharia, São José dos Campos SP, Brazil
- Universidade Federal de São Paulo, Departamento de Informática em Saúde, São Paulo SP, Brazil
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Kepper MM, Fowler LA, Kusters IS, Davis JW, Baqer M, Sagui-Henson S, Xiao Y, Tarfa A, Yi JC, Gibson B, Heron KE, Alberts NM, Burgermaster M, Njie-Carr VP, Klesges LM. Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity. J Med Internet Res 2024; 26:e51355. [PMID: 39088246 PMCID: PMC11327633 DOI: 10.2196/51355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 08/02/2024] Open
Abstract
The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.
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Affiliation(s)
- Maura M Kepper
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Lauren A Fowler
- Sexuality, Health, and Gender Center, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States
| | - Isabelle S Kusters
- Department of Health, Human, and Biomedical Sciences, University of Houston-Clear Lake, Houston, TX, United States
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Manal Baqer
- Neamah Health Consulting, Boston, MA, United States
| | - Sara Sagui-Henson
- Clinical Strategy and Research Team, Modern Health, San Francisco, CA, United States
| | - Yunyu Xiao
- Department of Population Health Science, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Adati Tarfa
- School of Medicine, Yale University, New Haven, CT, United States
| | - Jean C Yi
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kristin E Heron
- Psychology Department, Old Dominion University, Norfolk, VA, United States
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, United States
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Marissa Burgermaster
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, United States
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Veronica Ps Njie-Carr
- Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, MD, United States
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
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Largent EA, Karlawish J, Wexler A. From an idea to the marketplace: Identifying and addressing ethical and regulatory considerations across the digital health product-development lifecycle. BMC DIGITAL HEALTH 2024; 2:41. [PMID: 39130168 PMCID: PMC11308106 DOI: 10.1186/s44247-024-00098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/09/2024] [Indexed: 08/13/2024]
Abstract
Widespread adoption of digital health tools has the potential to improve health and health care for individuals and their communities, but realizing this potential requires anticipating and addressing numerous ethical and regulatory challenges. Here, we help digital health tool developers identify ethical and regulatory considerations - and opportunities to advance desirable outcomes - by organizing them within a general product-development lifecycle that spans generation of ideas to commercialization of a product.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason Karlawish
- Department of Medicine, Department of Medical Ethics and Health Policy, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Shaw J, Glover W. The Political Economy of Digital Health Equity: Structural Analysis. J Med Internet Res 2024; 26:e46971. [PMID: 38530341 PMCID: PMC11005444 DOI: 10.2196/46971] [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: 03/03/2023] [Revised: 06/30/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wiljeana Glover
- Technology, Operations, and Information Management Division, Babson College, Wellesley, MA, United States
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Siebelink NM, van Dam KN, Lukkien DRM, Boon B, Smits M, van der Poel A. Action Opportunities to Pursue Responsible Digital Care for People With Intellectual Disabilities: Qualitative Study. JMIR Ment Health 2024; 11:e48147. [PMID: 38416547 PMCID: PMC10938230 DOI: 10.2196/48147] [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: 04/13/2023] [Revised: 10/26/2023] [Accepted: 01/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Responsible digital care refers to any intentional systematic effort designed to increase the likelihood of a digital care technology developed through ethical decision-making, being socially responsible and aligned with the values and well-being of those impacted by it. OBJECTIVE We aimed to present examples of action opportunities for (1) designing "technology"; (2) shaping the "context" of use; and (3) adjusting the behavior of "users" to guide responsible digital care for people with intellectual disabilities. METHODS Three cases were considered: (1) design of a web application to support the preparation of meals for groups of people with intellectual disabilities, (2) implementation of an app to help people with intellectual disabilities regulate their stress independently, and (3) implementation of a social robot to stimulate interaction and physical activity among people with intellectual disabilities. Overall, 26 stakeholders participated in 3 multistakeholder workshops (case 1: 10/26, 38%; case 2: 10/26, 38%; case 3: 6/26, 23%) based on the "guidance ethics approach." We identified stakeholders' values based on bottom-up exploration of experienced and expected effects of using the technology, and we formulated action opportunities for these values in the specific context of use. Qualitative data were analyzed thematically. RESULTS Overall, 232 effects, 33 values, and 156 action opportunities were collected. General and case-specific themes were identified. Important stakeholder values included quality of care, autonomy, efficiency, health, enjoyment, reliability, and privacy. Both positive and negative effects could underlie stakeholders' values and influence the development of action opportunities. Action opportunities comprised the following: (1) technology: development of the technology (eg, user experience and customization), technology input (eg, recipes for meals, intervention options for reducing stress, and activities), and technology output (eg, storage and use of data); (2) context: guidelines, training and support, policy or agreements, and adjusting the physical environment in which the technology is used; and (3) users: integrating the technology into daily care practice, by diminishing (eg, "letting go" to increase the autonomy of people with intellectual disabilities), retaining (eg, face-to-face contact), and adding (eg, evaluation moments) certain behaviors of care professionals. CONCLUSIONS This is the first study to provide insight into responsible digital care for people with intellectual disabilities by means of bottom-up exploration of action opportunities to take account of stakeholders' values in designing technology, shaping the context of use, and adjusting the behavior of users. Although part of the findings may be generalized, case-specific insights and a complementary top-down approach (eg, predefined ethical frameworks) are essential. The findings represent a part of an ethical discourse that requires follow-up to meet the dynamism of stakeholders' values and further develop and implement action opportunities to achieve socially desirable, ethically acceptable, and sustainable digital care that improves the lives of people with intellectual disabilities.
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Affiliation(s)
| | - Kirstin N van Dam
- Academy Het Dorp, Arnhem, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Dirk R M Lukkien
- Vilans, Utrecht, Netherlands
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Brigitte Boon
- Academy Het Dorp, Arnhem, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Siza, Arnhem, Netherlands
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Těšinová JK, Dobiášová K, Dušek Z, Tobiášová A. Development of telemedicine in the Czech Republic from patients' and other key stakeholders' perspective. Front Public Health 2023; 11:1202182. [PMID: 37937075 PMCID: PMC10626478 DOI: 10.3389/fpubh.2023.1202182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Telemedicine is a way to improve healthcare outcomes with greater efficiency for both patients and care providers. The great potential of digital technologies also lies in strengthening the patient-centered approach. The early successes and benefits of telemedicine in the Czech Republic, amplified by the COVID-19, have contributed to the fact that wider implementation of telemedicine is already generally supported at the expert and public levels. Our research focuses on the identification of key issues in the implementation of telemedicine and the challenges of telemedicine in the future, from the perspective of patients and other stakeholders. The study is based on a qualitative research approach, combining focus groups with key stakeholders, patient panels and expert panels (2021-2022). The lack of rules and uncoordinated development of various activities proved to be the main barriers to the integration of telemedicine in the health system. This regulatory uncertainty can generate a number of problems in the patient-doctor relationship in practice, including ethical ones, and can also lead to inequalities in access to healthcare and affect the overall quality of care provided. Furthermore, it has been shown that patients' interests in the implementation of telemedicine are: 1. a predictable and reliable framework that guarantees them certainty and security in the provision of telemedicine services, 2. telemedicine solutions that increase the availability and efficiency of the care provided while bringing comfort, and 3. user-friendly and simple solutions. At the same time, patients want to understand the new environment and be active participants in the process of digital innovation, including the practical implementation of telemedicine. The research team has developed recommendations for further developments in the implementation of telemedicine that reflect the patient's interest and can be implemented at three levels - the health system, institutional, and community level. In countries with a well-developed and institutionalized patient movement, the community level can be represented by patient organizations, thus becoming the link between telemedicine policy making and implementation at the individual level of healthcare provision. For the further development of telemedicine, the development of a national strategy involving all key stakeholders, including patients, in the implementation has proven essential.
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Affiliation(s)
- Jolana Kopsa Těšinová
- Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Karolína Dobiášová
- Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Prague, Czechia
| | | | - Alena Tobiášová
- Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Prague, Czechia
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Haltaufderheide J, Viero D, Krämer D. Cultural Implications Regarding Privacy in Digital Contact Tracing Algorithms: Method Development and Empirical Ethics Analysis of a German and a Japanese Approach to Contact Tracing. J Med Internet Res 2023; 25:e45112. [PMID: 37379062 PMCID: PMC10365635 DOI: 10.2196/45112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Digital contact tracing algorithms (DCTAs) have emerged as a means of supporting pandemic containment strategies and protecting populations from the adverse effects of COVID-19. However, the impact of DCTAs on users' privacy and autonomy has been heavily debated. Although privacy is often viewed as the ability to control access to information, recent approaches consider it as a norm that structures social life. In this regard, cultural factors are crucial in evaluating the appropriateness of information flows in DCTAs. Hence, an important part of ethical evaluations of DCTAs is to develop an understanding of their information flow and their contextual situatedness to be able to adequately evaluate questions about privacy. However, only limited studies and conceptual approaches are currently available in this regard. OBJECTIVE This study aimed to develop a case study methodology to include contextual cultural factors in ethical analysis and present exemplary results of a subsequent analysis of 2 different DCTAs following this approach. METHODS We conducted a comparative qualitative case study of the algorithm of the Google Apple Exposure Notification Framework as exemplified in the German Corona Warn App and the Japanese approach of Computation of Infection Risk via Confidential Locational Entries (CIRCLE) method. The methodology was based on a postphenomenological perspective, combined with empirical investigations of the technological artifacts within their context of use. An ethics of disclosure approach was used to focus on the social ontologies created by the algorithms and highlight their connection to the question about privacy. RESULTS Both algorithms use the idea of representing a social encounter of 2 subjects. These subjects gain significance in terms of risk against the background of a representation of their temporal and spatial properties. However, the comparative analysis reveals 2 major differences. Google Apple Exposure Notification Framework prioritizes temporality over spatiality. In contrast, the representation of spatiality is reduced to distance without any direction or orientation. However, the CIRCLE framework prioritizes spatiality over temporality. These different concepts and prioritizations can be seen to align with important cultural differences in considering basic concepts such as subject, time, and space in Eastern and Western thought. CONCLUSIONS The differences noted in this study essentially lead to 2 different ethical questions about privacy that are raised against the respective backgrounds. These findings have important implications for the ethical evaluation of DCTAs, suggesting that a culture-sensitive assessment is required to ensure that technologies fit into their context and create less concern regarding their ethical acceptability. Methodologically, our study provides a basis for an intercultural approach to the ethics of disclosure, allowing for cross-cultural dialogue that can overcome mutual implicit biases and blind spots based on cultural differences.
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Affiliation(s)
- Joschka Haltaufderheide
- Medical Ethics With Focus on Digitization, Joint Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Davide Viero
- Faculty of Educational Sciences, University of Duisburg-Essen, Essen, Germany
| | - Dennis Krämer
- Faculty of Social Sciences, Georg-August-University Göttingen, Göttingen, Germany
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Martinez-Martin N. Viewing CAI as a Tool Within the Mental Health Care System. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:57-59. [PMID: 37130393 DOI: 10.1080/15265161.2023.2191058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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11
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Shaw J, Sekalala S. Health data justice: building new norms for health data governance. NPJ Digit Med 2023; 6:30. [PMID: 36854964 PMCID: PMC9972302 DOI: 10.1038/s41746-023-00780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
The retention and use of health-related data by government, corporate, and health professional actors risk exacerbating the harms of colonial systems of inequality in which health care and public health are situated, regardless of the intentions about how those data are used. In this context, a data justice perspective presents opportunities to develop new norms of health-related data governance that hold health justice as the primary objective. In this perspective, we define the concept of health data justice, outline urgent issues informed by this approach, and propose five calls to action from a health data justice perspective.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Sharifah Sekalala
- grid.7372.10000 0000 8809 1613School of Law, University of Warwick, Coventry, CV4 7AL United Kingdom
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Macri R, Roberts SL. The Use of Artificial Intelligence in Clinical Care: A Values-Based Guide for Shared Decision Making. Curr Oncol 2023; 30:2178-2186. [PMID: 36826129 PMCID: PMC9955933 DOI: 10.3390/curroncol30020168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023] Open
Abstract
Clinical applications of artificial intelligence (AI) in healthcare, including in the field of oncology, have the potential to advance diagnosis and treatment. The literature suggests that patient values should be considered in decision making when using AI in clinical care; however, there is a lack of practical guidance for clinicians on how to approach these conversations and incorporate patient values into clinical decision making. We provide a practical, values-based guide for clinicians to assist in critical reflection and the incorporation of patient values into shared decision making when deciding to use AI in clinical care. Values that are relevant to patients, identified in the literature, include trust, privacy and confidentiality, non-maleficence, safety, accountability, beneficence, autonomy, transparency, compassion, equity, justice, and fairness. The guide offers questions for clinicians to consider when adopting the potential use of AI in their practice; explores illness understanding between the patient and clinician; encourages open dialogue of patient values; reviews all clinically appropriate options; and makes a shared decision of what option best meets the patient's values. The guide can be used for diverse clinical applications of AI.
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Affiliation(s)
- Rosanna Macri
- Department of Bioethics, Sinai Health, Toronto, ON M5G 1X5, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P8, Canada
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P5, Canada
- Correspondence:
| | - Shannon L. Roberts
- Project-Specific Bioethics Research Volunteer Student, Hennick Bridgepoint Hospital, Sinai Health, Toronto, ON M4M 2B5, Canada
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Landers C, Vayena E, Amann J, Blasimme A. Stuck in translation: Stakeholder perspectives on impediments to responsible digital health. Front Digit Health 2023; 5:1069410. [PMID: 36815171 PMCID: PMC9939685 DOI: 10.3389/fdgth.2023.1069410] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
Spurred by recent advances in machine learning and electronic hardware, digital health promises to profoundly transform medicine. At the same time, however, it raises conspicuous ethical and regulatory issues. This has led to a growing number of calls for responsible digital health. Based on stakeholder engagement methods, this paper sets out to identify core impediments hindering responsible digital health in Switzerland. We developed a participatory research methodology to access stakeholders' fragmented knowledge of digital health, engaging 46 digital health stakeholders over a period of five months (December 2020-April 2021). We identified ineffective stakeholder collaboration, lack of ethical awareness among digital health innovators, and lack of relevant regulation as core impediments to responsible digital health. The stakeholders' accounts indicate that ethical concerns may considerably slow the pace of digital health innovation - implying that responsible innovation is a core catalyst for the progress of digital health overall.
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Affiliation(s)
- Constantin Landers
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Julia Amann
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland,Strategy and Innovation, Careum Foundation, Zurich, Switzerland
| | - Alessandro Blasimme
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland,Correspondence: Alessandro Blasimme
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Borda A, Molnar A, Heys M, Musyimi C, Kostkova P. Editorial: Digital interventions and serious mobile games for health in low- and middle-income countries (LMICs). Front Public Health 2023; 11:1153971. [PMID: 36875377 PMCID: PMC9975710 DOI: 10.3389/fpubh.2023.1153971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Ann Borda
- Faculty of Medicine, Dental and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Department of Information Studies, University College London, London, United Kingdom
| | - Andreea Molnar
- Department of Computing Technologies, Swinburne University, Melbourne, VIC, Australia
| | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health (GOS ICH), University College London, London, United Kingdom
| | - Christine Musyimi
- Africa Mental Health Training and Research Foundation (AMHRTF), Nairobi, Kenya
| | - Patty Kostkova
- UCL Centre for Digital Public Heath in Emergencies (dPHE), University College London, London, United Kingdom
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Ranney ML, Stettenbauer EG, Delgado MK, Yao KA, Orchowski LM. Uses of mHealth in Injury Prevention and Control: a Critical Review. CURR EPIDEMIOL REP 2022; 9:273-281. [PMID: 36404873 PMCID: PMC9644389 DOI: 10.1007/s40471-022-00312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
Purpose of Reviews The purpose of this review was to summarize the current state of the literature on the use of "mHealth" (the use of mobile devices for health promotion) for injury prevention and control. Recent Findings mHealth is being used to measure, predict, and prevent the full spectrum of injuries. However, most literature remains preliminary or in a pilot stage. Use of best-of-class design principles (e.g., user-centered design, theory-based development) is uncommon, and wide-scale dissemination of effective monitoring or intervention tools is rare. Summary mHealth for injury prevention holds promise, but further work is needed across the full spectrum of development and translation.
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Affiliation(s)
- Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School Brown University, Providence, USA
- Brown-Lifespan Center for Digital Health, Providence, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
| | - E. G. Stettenbauer
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, USA
| | - M. Kit Delgado
- Department of Emergency Medicine and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA
| | | | - Lindsay M. Orchowski
- Brown-Lifespan Center for Digital Health, Providence, USA
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI USA
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16
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Istasy P, Lee WS, Iansavichene A, Upshur R, Gyawali B, Burkell J, Sadikovic B, Lazo-Langner A, Chin-Yee B. The Impact of Artificial Intelligence on Health Equity in Oncology: Scoping Review. J Med Internet Res 2022; 24:e39748. [PMID: 36005841 PMCID: PMC9667381 DOI: 10.2196/39748] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The field of oncology is at the forefront of advances in artificial intelligence (AI) in health care, providing an opportunity to examine the early integration of these technologies in clinical research and patient care. Hope that AI will revolutionize health care delivery and improve clinical outcomes has been accompanied by concerns about the impact of these technologies on health equity. OBJECTIVE We aimed to conduct a scoping review of the literature to address the question, "What are the current and potential impacts of AI technologies on health equity in oncology?" METHODS Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases from January 2000 to August 2021 for records engaging with key concepts of AI, health equity, and oncology. We included all English-language articles that engaged with the 3 key concepts. Articles were analyzed qualitatively for themes pertaining to the influence of AI on health equity in oncology. RESULTS Of the 14,011 records, 133 (0.95%) identified from our review were included. We identified 3 general themes in the literature: the use of AI to reduce health care disparities (58/133, 43.6%), concerns surrounding AI technologies and bias (16/133, 12.1%), and the use of AI to examine biological and social determinants of health (55/133, 41.4%). A total of 3% (4/133) of articles focused on many of these themes. CONCLUSIONS Our scoping review revealed 3 main themes on the impact of AI on health equity in oncology, which relate to AI's ability to help address health disparities, its potential to mitigate or exacerbate bias, and its capability to help elucidate determinants of health. Gaps in the literature included a lack of discussion of ethical challenges with the application of AI technologies in low- and middle-income countries, lack of discussion of problems of bias in AI algorithms, and a lack of justification for the use of AI technologies over traditional statistical methods to address specific research questions in oncology. Our review highlights a need to address these gaps to ensure a more equitable integration of AI in cancer research and clinical practice. The limitations of our study include its exploratory nature, its focus on oncology as opposed to all health care sectors, and its analysis of solely English-language articles.
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Affiliation(s)
- Paul Istasy
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Wen Shen Lee
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine, Western University, London, ON, Canada
| | | | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jacquelyn Burkell
- Faculty of Information and Media Studies, Western University, London, ON, Canada
| | - Bekim Sadikovic
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine, Western University, London, ON, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Benjamin Chin-Yee
- Rotman Institute of Philosophy, Western University, London, ON, Canada
- Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
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17
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Boyer P, Donia J, Whyne C, Burns D, Shaw J. Regulatory regimes and procedural values for health-related motion data in the United States and Canada. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Martinez-Martin N. Envisioning a Path toward Equitable and Effective Digital Mental Health. AJOB Neurosci 2022; 13:196-198. [PMID: 35797130 PMCID: PMC9295896 DOI: 10.1080/21507740.2022.2082597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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19
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Mather C, Almond H. Using COMPASS ( Context Optimisation Model for Person-Centred Analysis and Systematic Solutions) Theory to Augment Implementation of Digital Health Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127111. [PMID: 35742360 PMCID: PMC9222784 DOI: 10.3390/ijerph19127111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Digital health research is an emerging discipline that requires easy-to-understand theoretical frameworks and implementation models for digital health providers in health and social care settings. The COVID-19 pandemic has heightened the demand for digital health discipline-specific instruction on how to manage evidence-based digital health transformation. Access to the use of these models guarantees that digital health providers can investigate phenomena using safe and suitable approaches and methods to conduct research and identify answers to challenges and problems that arise in health and social care settings. The COMPASS theory is designed to aid transformation of health and social care environments. A navigational rose of primary quadrants is divided by four main compass points, with person-centred care being central to the philosophy. Two axes produce Cartesian planes that intersect to form a box plot, which can be used to discover human and physical resource weightings to augment digital health research design and implementation. A third continuum highlights stakeholders’ capabilities, which are critical for any multidisciplinary study. The COMPASS mnemonic guides end users through the process of design, development, implementation, evaluation, and communication of digital health transformations. The theory’s foundations are presented and explained in context of the ‘new normal’ of health and social care delivery.
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Affiliation(s)
- Carey Mather
- School of Nursing, University of Tasmania, Newnham 7248, Australia
- Correspondence: ; Tel.: +61-3-6324-3149
| | - Helen Almond
- Australian Institute of Health Service Management, University of Tasmania, Hobart 7005, Australia;
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20
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Shaw J. Emerging Paradigms for Ethical Review of Research Using Artificial Intelligence. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:42-44. [PMID: 35475953 DOI: 10.1080/15265161.2022.2055206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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21
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Steerling E, Houston R, Gietzen LJ, Ogilvie SJ, de Ruiter HP, Nygren JM. Examining how ethics in relation to health technology is described in the research literature: A Scoping Review (Preprint). Interact J Med Res 2022; 11:e38745. [PMID: 35969434 PMCID: PMC9425162 DOI: 10.2196/38745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emilie Steerling
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Rebecca Houston
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Luke J Gietzen
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Sarah J Ogilvie
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Hans-Peter de Ruiter
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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