Oxford University Hospital NHS Foundation Trust, Oxford, UK.
Oxford Brookes University, Oxford, UK.
J Adv Nurs. 2024 Sep;80(9):3516-3532. doi: 10.1111/jan.16104. Epub 2024 Feb 21.
This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth.
Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood.
A systematic integrative review.
Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar.
This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data.
The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor.
The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors.
Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth.
Not applicable.
本系统综合文献回顾探讨了临床医生如何在远程医疗中为患者管理计划做出决策。
远程医疗是一种护理模式，由于数字技术的发展和 COVID-19 大流行而变得流行。人们认识到，与传统临床环境相比，由于其虚拟特性，远程医疗对患者的风险更高。尽管医疗服务的格局越来越倾向于虚拟系统，但远程医疗中的决策过程仍未完全理解。
系统综合评价。
数据库包括 CINAHL、APA PsycInfo、学术搜索综合、PubMed、Web of Science 和 Google Scholar。
本系统综合审查方法由 Whittemore 和 Knafl（2005）提供。2022 年 11 月，数据库首次使用关键词进行搜索，然后于 2023 年 10 月重复搜索。进行主题综合分析和综合数据。
搜索确定了 382 篇文章。经过筛选，只有 10 篇文章符合入选标准并被纳入。五项研究为定性研究，一项为定量研究，四项为混合方法研究。确定了与远程医疗决策过程相关的五个主要主题：远程医疗决策的特点、患者因素、临床医生因素、CDSS 因素和外部影响因素。
远程医疗中的决策过程是一个复杂的认知过程，受多方面因素的影响，包括患者因素、临床医生因素、外部影响因素和技术因素。
远程医疗比面对面接触带来更高的风险和不确定性。CDSS 似乎没有带来统一性和清晰度，反而带来了更多的分歧和模糊性。远程医疗中的一些临床推理过程尚不清楚，需要进行表述和透明化，使初级临床医生具备技能，以最小化远程医疗相关风险。
不适用。
