Nassehi Damoun, Gripsrud Birgitta Haga, Ramvi Ellen
Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Interact J Med Res. 2024 May 15;13:e47280. doi: 10.2196/47280.
The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration.
This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics.
Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings.
Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health.
The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies.
数字健康技术的出现改变了医疗保健的格局，影响着医患关系的动态变化。尽管这些技术带来了潜在的益处，但它们也带来了需要伦理考量的挑战和复杂性。
本范围综述旨在研究数字信息、远程医疗和电子健康记录等数字健康技术对医患关系的影响。为了理解这些工具在医疗保健中的复杂后果，它将使用各种理论框架和概念的研究结果与基于关系伦理的研究结果进行对比。
我们使用PRISMA-ScR（系统评价和Meta分析扩展版的范围综述首选报告项目）指南进行了范围综述。通过在MEDLINE/PubMed、Embase、IEEE Xplore和Cochrane上进行关键词搜索来检索数据。我们筛选了2010年至2021年期间发表在英文期刊上的427篇经同行评审的原创研究论文。总共评估了73篇论文的 eligibility，其中10篇被纳入综述。通过对研究结果的叙述性综合来总结数据。
数字健康技术增强了沟通，提高了医疗保健服务效率，并赋予患者权力，导致医患关系中的权力动态发生变化。由于患者技术素养的差异，它们还可能加剧医疗保健获取方面的不平等，并由于数字互动的非个性化性质导致患者满意度下降。应用关系伦理框架的研究揭示了数字健康技术对医患关系的细微影响，突出了向更具协作性和互惠性的护理的转变。这些研究还探讨了从传统等级关系向相互参与的转变，捕捉了权力动态和脆弱性的复杂性。其他理论框架，如以患者为中心的护理，以及概念，如患者赋权，对于在数字健康背景下理解这些互动也很有价值。
医患关系从等级模式向协作模式的转变不仅凸显了数字工具的赋权潜力，也带来了新的挑战并强化了现有挑战。除了各种理论框架和概念的应用外，本综述还强调了关系伦理视角的独特全面性，它可以在数字健康背景下对信任、同理心和权力动态提供更细微的理解。在实证研究中采用关系伦理可能会为数字技术介导的医患关系的现实生活复杂性提供更丰富的见解。
