Senek Michaela, Drummond David, Pinnock Hilary, Hansen Kjeld, Ankolekar Anshu, O'Connor Úna, Gonsard Apolline, Mazulov Oleksandr, Sreter Katherina Bernadette, Thornton Christina, Powell Pippa
School of Medicine and Population Health, Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom.
Department of Pediatric Pulmonology and Allergology, University Hospital Necker Enfants Malades, APHP, Université Paris Cité, Paris, France.
J Med Internet Res. 2025 May 30;27:e70970. doi: 10.2196/70970.
Digital health technology adoption has accelerated in respiratory care, particularly since the COVID-19 pandemic, supporting various applications from self-management to telerehabilitation. While these technologies have transformed health care delivery, their impact on the patient-provider relationship in specialist respiratory care remains poorly understood.
This study aims to systematically review the literature on the impact of digital health technology on the patient-provider relationship in respiratory secondary care settings and to understand the factors that enhance or diminish this relationship.
In December 2023, we conducted a systematic review following Cochrane methodology, searching MEDLINE, Embase, CINAHL, Cochrane databases, and PsycINFO. We included qualitative, quantitative, and mixed methods studies examining digital health interventions in respiratory secondary care. Trained volunteers from the European Respiratory Society CONNECT Clinical Research Collaboration performed screening and data extraction. We conducted a qualitative meta-synthesis of findings, followed by an abductive quantitative data analysis. A total of 3 stakeholder workshops were held to interpret findings collaboratively with patients and health care professionals.
From 15,779 papers screened, 97 met the inclusion criteria (55 qualitative/mixed-methods studies, 42 quantitative studies). Studies covered various respiratory conditions, including COPD (32%), asthma (26%), and COVID-19 (13%). Four main themes emerged: trust (foundational to the relationship), adoption factors (including clinical context and implementation drivers), confidence in technology (based on functionality and the evidence base), and connection (encompassing communication and a caring presence). Digital health technology can either enhance or diminish trust between patients and clinicians, with patients' perceptions of the motivations behind its implementation being crucial. While technology facilitated access and communication, remote consultations risked depersonalisation, particularly when not balanced with in-person interactions. Self-monitoring and access to information empowered patients and promoted more equitable patient-provider relationships.
Digital health technology can either strengthen or weaken patient-provider relationships in respiratory care, with effects impacted by adoption factors, confidence in technology, connection, and patient empowerment. Maintaining trust in the era of digital care requires transparent implementation of motivations, consideration of individual circumstances, and reliable technology that supports rather than replaces the therapeutic relationship.
PROSPERO CRD42024493664; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024493664.
自新冠疫情以来，数字健康技术在呼吸护理领域的应用加速，支持了从自我管理到远程康复等各种应用。虽然这些技术改变了医疗服务的提供方式，但它们对专科呼吸护理中患者与医护人员关系的影响仍知之甚少。
本研究旨在系统回顾关于数字健康技术对呼吸二级护理环境中患者与医护人员关系影响的文献，并了解增强或削弱这种关系的因素。
2023年12月，我们按照Cochrane方法进行了一项系统综述，检索了MEDLINE、Embase、CINAHL、Cochrane数据库和PsycINFO。我们纳入了定性、定量和混合方法研究，这些研究考察了呼吸二级护理中的数字健康干预措施。来自欧洲呼吸学会CONNECT临床研究协作组的经过培训的志愿者进行筛选和数据提取。我们对研究结果进行了定性元综合分析，随后进行了归纳性定量数据分析。共举办了3次利益相关者研讨会，与患者和医护人员合作解读研究结果。
在筛选的15779篇论文中，97篇符合纳入标准（55篇定性/混合方法研究，42篇定量研究）。研究涵盖了各种呼吸疾病，包括慢性阻塞性肺疾病（32%）、哮喘（26%）和新冠（13%）。出现了四个主要主题：信任（关系的基础）、采用因素（包括临床背景和实施驱动因素）、对技术的信心（基于功能和证据基础）以及联系（包括沟通和关怀的存在）。数字健康技术既可以增强也可以削弱患者与临床医生之间的信任，患者对其实施背后动机的看法至关重要。虽然技术促进了获取和沟通，但远程会诊存在非个性化的风险，尤其是在与面对面互动不平衡的情况下。自我监测和获取信息增强了患者的能力，促进了更公平的患者与医护人员关系。
数字健康技术在呼吸护理中既可以加强也可以削弱患者与医护人员的关系，其效果受到采用因素、对技术的信心、联系和患者赋权的影响。在数字护理时代维持信任需要透明地实施动机、考虑个体情况以及支持而非取代治疗关系的可靠技术。
PROSPERO CRD42024493664；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024493664 。
