Ignatowicz Agnieszka, Slowther Anne-Marie, Elder Patrick, Bryce Carol, Hamilton Kathryn, Huxley Caroline, Forjaz Vera, Sturt Jackie, Griffiths Frances
Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
BMC Med Ethics. 2018 Feb 23;19(1):11. doi: 10.1186/s12910-018-0250-0.
Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions.
A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms.
Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician's duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication.
The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to.
患者与其临床医生之间的数字通信为改善患者护理提供了潜力，特别是对于有脱离服务风险的患有长期疾病的年轻人。然而，其使用引发了一些伦理问题，实证研究中尚未对这些问题进行探讨。本研究的目的是从患者和临床医生的角度，考察在患有长期疾病的年轻人背景下使用数字临床通信的伦理影响。
作为LYNC研究的一部分，对来自英国20家专科诊所的129人进行了半结构化访谈，其中59名是年轻人，70名是医疗保健专业人员。核心团队阅读了来自五个科室（癌症、肝脏、肾脏、囊性纤维化和心理健康）的访谈记录，以识别明确和隐含的伦理问题，并制定描述性伦理准则。我们随后的主题分析是参照专业和伦理规范反复进行的。
临床医生参与者认为数字临床通信可能会增强患者的权能和自主性；改善患者与医疗保健专业人员之间的信任；并由于能够快速获得临床建议而减少伤害。然而，他们也描述了伦理挑战，包括：难以界定和维持保密界限；所需同意程度的不确定性；以及在可能无限制访问的情况下临床医生注意义务界限的模糊。矛盾的是，数字临床通信的使用可能会在一些患者中造成依赖而非促进自主性。患者参与者对数字通信背景下的保密性理解和关注各不相同。数据中出现的一个总体主题是，在使用临床数字通信的背景下，患者与临床医生关系的界限以及专业注意义务发生了变化。
临床数字通信的伦理影响是复杂的，且超出了对保密和同意的关注。这种通信形式的任何发展都应考虑其对患者与临床医生关系的影响，并包括适当的保障措施，以确保遵守专业伦理义务。
