Paccoud Ivana, Leist Anja K, Schwaninger Isabel, van Kessel Robin, Klucken Jochen
Digital Medicine Group, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.
Digital Medicine, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.
Digit Health. 2024 Oct 1;10:20552076241277705. doi: 10.1177/20552076241277705. eCollection 2024 Jan-Dec.
Digitalization in medicine offers a significant opportunity to transform healthcare systems by providing novel digital tools and services to guide personalized prevention, prediction, diagnosis, treatment and disease management. This transformation raises a number of novel socio-ethical considerations for individuals and society as a whole, which need to be appropriately addressed to ensure that digital medical devices (DMDs) are widely adopted and benefit all patients as well as healthcare service providers. In this narrative review, based on a broad literature search in PubMed, Web of Science, Google Scholar, we outline five core socio-ethical considerations in digital medicine that intersect with the notions of equity and digital inclusion: (i) access, use and engagement with DMDs, (ii) inclusiveness in DMD clinical trials, (iii) algorithm fairness, (iv) surveillance and datafication, and (v) data privacy and trust. By integrating literature from multidisciplinary fields, including social, medical, and computer sciences, we shed light on challenges and opportunities related to the development and adoption of DMDs. We begin with an overview of the different types of DMDs, followed by in-depth discussions of five socio-ethical implications associated with their deployment. Concluding our review, we provide evidence-based multilevel recommendations aimed at fostering a more inclusive digital landscape to ensure that the development and integration of DMDs in healthcare mitigate rather than cause, maintain or exacerbate health inequities.
医学数字化提供了一个重大机遇，通过提供新颖的数字工具和服务来指导个性化预防、预测、诊断、治疗和疾病管理，从而改变医疗保健系统。这种转变给个人乃至整个社会带来了一些新的社会伦理考量，需要加以妥善解决，以确保数字医疗设备（DMD）得到广泛应用，并使所有患者以及医疗服务提供者受益。在这篇叙述性综述中，基于在PubMed、科学网、谷歌学术上进行的广泛文献检索，我们概述了数字医学中与公平和数字包容概念相关的五个核心社会伦理考量：（i）DMD的获取、使用和参与度；（ii）DMD临床试验的包容性；（iii）算法公平性；（iv）监测与数据化；（v）数据隐私与信任。通过整合来自社会、医学和计算机科学等多学科领域的文献，我们阐明了与DMD开发和应用相关的挑战与机遇。我们首先概述不同类型的DMD，随后深入讨论与其部署相关的五个社会伦理影响。在综述结尾，我们提供基于证据的多层次建议，旨在营造一个更具包容性的数字环境，以确保DMD在医疗保健中的开发和整合能够减少而非导致、维持或加剧健康不平等现象。
