Nghiem Jodie, Adler Daniel A, Estrin Deborah, Livesey Cecilia, Choudhury Tanzeem
Medical College, Weill Cornell Medicine, New York, NY, United States.
College of Computing and Information Science, Cornell Tech, New York, NY, United States.
JMIR Form Res. 2023 Aug 10;7:e47380. doi: 10.2196/47380.
Digital health-tracking tools are changing mental health care by giving patients the ability to collect passively measured patient-generated health data (PGHD; ie, data collected from connected devices with little to no patient effort). Although there are existing clinical guidelines for how mental health clinicians should use more traditional, active forms of PGHD for clinical decision-making, there is less clarity on how passive PGHD can be used.
We conducted a qualitative study to understand mental health clinicians' perceptions and concerns regarding the use of technology-enabled, passively collected PGHD for clinical decision-making. Our interviews sought to understand participants' current experiences with and visions for using passive PGHD.
Mental health clinicians providing outpatient services were recruited to participate in semistructured interviews. Interview recordings were deidentified, transcribed, and qualitatively coded to identify overarching themes.
Overall, 12 mental health clinicians (n=11, 92% psychiatrists and n=1, 8% clinical psychologist) were interviewed. We identified 4 overarching themes. First, passive PGHD are patient driven-we found that current passive PGHD use was patient driven, not clinician driven; participating clinicians only considered passive PGHD for clinical decision-making when patients brought passive data to clinical encounters. The second theme was active versus passive data as subjective versus objective data-participants viewed the contrast between active and passive PGHD as a contrast between interpretive data on patients' mental health and objective information on behavior. Participants believed that prioritizing passive over self-reported, active PGHD would reduce opportunities for patients to reflect upon their mental health, reducing treatment engagement and raising questions about how passive data can best complement active data for clinical decision-making. Third, passive PGHD must be delivered at appropriate times for action-participants were concerned with the real-time nature of passive PGHD; they believed that it would be infeasible to use passive PGHD for real-time patient monitoring outside clinical encounters and more feasible to use passive PGHD during clinical encounters when clinicians can make treatment decisions. The fourth theme was protecting patient privacy-participating clinicians wanted to protect patient privacy within passive PGHD-sharing programs and discussed opportunities to refine data sharing consent to improve transparency surrounding passive PGHD collection and use.
Although passive PGHD has the potential to enable more contextualized measurement, this study highlights the need for building and disseminating an evidence base describing how and when passive measures should be used for clinical decision-making. This evidence base should clarify how to use passive data alongside more traditional forms of active PGHD, when clinicians should view passive PGHD to make treatment decisions, and how to protect patient privacy within passive data-sharing programs. Clear evidence would more effectively support the uptake and effective use of these novel tools for both patients and their clinicians.
数字健康追踪工具正在改变心理健康护理方式，使患者能够收集被动测量的患者生成的健康数据（PGHD；即从连接设备收集的数据，患者几乎无需付出努力）。尽管现有临床指南针对心理健康临床医生应如何使用更传统的、主动形式的PGHD进行临床决策，但对于如何使用被动PGHD却不太明确。
我们进行了一项定性研究，以了解心理健康临床医生对于使用技术支持的、被动收集的PGHD进行临床决策的看法和担忧。我们的访谈旨在了解参与者目前使用被动PGHD的经历以及对其的展望。
招募提供门诊服务的心理健康临床医生参与半结构化访谈。访谈录音进行去识别化处理、转录并进行定性编码，以确定总体主题。
总共采访了12名心理健康临床医生（n = 11，92%为精神科医生，n = 1，8%为临床心理学家）。我们确定了4个总体主题。首先，被动PGHD由患者驱动——我们发现目前被动PGHD的使用是由患者驱动的，而非临床医生驱动；只有当患者在临床就诊时带来被动数据时，参与访谈的临床医生才会考虑将被动PGHD用于临床决策。第二个主题是主动数据与被动数据作为主观数据与客观数据——参与者将主动和被动PGHD之间的对比视为患者心理健康的解释性数据与行为客观信息之间的对比。参与者认为，相较于自我报告的主动PGHD，优先考虑被动PGHD会减少患者反思其心理健康的机会，降低治疗参与度，并引发关于被动数据如何才能最佳地补充主动数据用于临床决策的问题。第三，被动PGHD必须在适当的行动时间提供——参与者关注被动PGHD的实时性；他们认为在临床就诊之外使用被动PGHD进行实时患者监测是不可行的，而在临床就诊期间临床医生能够做出治疗决策时使用被动PGHD则更可行。第四个主题是保护患者隐私——参与访谈的临床医生希望在被动PGHD共享计划中保护患者隐私，并讨论了完善数据共享同意书的机会，以提高被动PGHD收集和使用的透明度。
尽管被动PGHD有潜力实现更具情境化的测量，但本研究强调需要建立并传播一个证据库，描述被动测量应如何以及何时用于临床决策。该证据库应阐明如何将被动数据与更传统形式的主动PGHD一起使用，临床医生应何时查看被动PGHD以做出治疗决策，以及如何在被动数据共享计划中保护患者隐私。明确的证据将更有效地支持患者及其临床医生采用并有效使用这些新型工具。
