Cristin-prosjekt-ID: 2517836
Sist endret: 24. oktober 2021, 23:29

Cristin-prosjekt-ID: 2517836
Sist endret: 24. oktober 2021, 23:29
Prosjekt

Relational Ethics in Technology-Mediated Medical Practice

prosjektleder

Damoun Nassehi
ved Avdeling for omsorg og etikk ved Universitetet i Stavanger

prosjekteier / koordinerende forskningsansvarlig enhet

  • Avdeling for omsorg og etikk ved Universitetet i Stavanger

Finansiering

  • Norges forskningsråd
    Prosjektkode: 301827

Kontaktinformasjon

Telefon
45426096
Sted
Damoun Nassehi

Tidsramme

Aktivt
Start: 1. september 2021 Slutt: 31. august 2024

Beskrivelse Beskrivelse

Tittel

Relational Ethics in Technology-Mediated Medical Practice

Populærvitenskapelig sammendrag

The project will explore the basis for a modern approach to medicine which is not controlled by nor reacts to technological developments but bridles the forces of advance to the benefit of patients.

Technologies such as tele- and blended-health, artificial intelligence, nanotechnology, augmented and virtual reality are changing the doctor-patient relationship, diagnostic methods, therapy options, bioethics, and health policies.

In medical practice, a doctor’s main objectives are to diagnose and treat disease. But a doctor, especially a General Practitioner (GP), does so much more. Inexperienced or overworked GPs may fall back on their biomedical reflexes, developed over years of study and internships at hospitals, but it is through their relationships with their patients that they can become holistic healers.

These skills, developed over time and through relationships with the patients, do not translate directly through technology. An AI cannot interpret what is not directly recorded as text or images in the EHR, and valuable information from the doctor-patient relationship is lost during digitisation. Also, a doctor’s personality and non-reflective actions can help cure but also contribute to maintain the patient’s illness or make it worse. Use of technology introduces a new, complex dimension to this relationship, and we should take time to investigate and evaluate the different ways technology may impact relations in medical practice. The potential as well as risk of technology is that it makes it is easy to reach a higher number of patients faster and with less effort. It is therefore more effective at both helping or harming more patients than a single physician would be able to help or harm in a lifetime.

Vitenskapelig sammendrag

Technologies such as tele- and blended-health, artificial intelligence, augmented and virtual reality, 3D printing, nanotechnology, robotics, digital security and privacy are changing the doctor-patient relationship, diagnostic methods, therapy options, pharmacological development, surgical methods, patient-care-services, bioethics, and health policies.

In medical practice, a doctor’s main objectives are to diagnose and treat disease. But a doctor, especially a General Practitioner (GP), does so much more. Inexperienced or overworked GPs may fall back on their biomedical reflexes, developed over years of study and internships at hospitals, but it is through their relationships with their patients that they can become holistic healers.

These skills, developed over time and through relationships with the patients, do not translate directly through technology. An AI cannot interpret what is not directly recorded as text or images in the EHR, and valuable information from the doctor-patient relationship is lost during digitisation. Also, a doctor’s personality and non-reflective actions can help cure but also contribute to maintain the patient’s illness or make it worse. Use of technology introduces a new, complex dimension to this relationship, and we should take time to investigate and evaluate the different ways technology may impact relations in medical practice. The potential as well as risk of technology is that it makes it is easy to reach a higher number of patients faster and with less effort. It is therefore more effective at both helping or harming more patients than a single physician would be able to help or harm in a lifetime.

Large, commercial companies are taking an interest in the healthcare market, and many apps and internet-connected devices, such as Apple’s smartwatch, have been made available to patients. These devices produce large amounts of data, as well as nudging and prompting the user. In Sweden, but also in Norway, a few private companies with substantial funding, are trying to corner the market by appealing to upper middle-class city dwellers with minor health problems. This can result in an increased engagement and improvement in overall health in Norway, as well as alleviate some of the increasing pressure on the public healthcare system. Alternatively, it can result in an increased medicalisation of the public and an unhealthy focus on biomedical data instead of a holistic approach to the patient.

Significance of the research project

Digital technologies are already shaping medical practice. In order to take control and harness this new wave of technology, we must first examine, analyse, and understand it. This research project will enable this to some extent. The research can be used to explore the basis for a modern approach to medicine which neither is controlled by, nor reacts to developments in digital health technology. Instead, it should enable physicians to bridle the forces of technological advance in order to ensure optimal benefit for patients.

Aims

The goal of this project is to explore the dissonance between the binary principles enforced by digital technologies and the inherent uncertainty in the holistic approach in family medicine.

To explore and examine how the use of technology changes the physician’s roles and approach to the diagnostic process and the doctor-patient relationship.

It will be prudent to identify basic principles upon which physicians can rely, so they won’t be overwhelmed by the development and incorporation of digital health technologies into clinical practice and in society as a whole.

Metode

This is a two-step project which begins with a literature review, and ends with a series of semi-structured interviews, that are then analysed by systematic text-condensation (STC) according to Malterud (26).

Since the body of research on the subject is trivial, we believe a literature review should be performed to identify and evaluate gaps in the existing research. The review will be used as a basis for developing a semi-structured interview guide. This will then be used in the second study to gain a deeper understanding of the interview subjects’ experiences and understanding of a technology-mediated medical practice.

Design and data sources

The literature review will be based partly on a pubmed search, as well as a review of digital technology related research papers published in leading peer-reviewed medical and technology journals as well as high-circulating throwaway journals. In addition, books, articles, and interviews on the subject by contemporary authors such as Eric Topol, Yuval Noah Harari, Jaron Lanier, Jörg Goldhahn, and Carl Edvard Rudebeck will be reviewed. This will help identify relevant theories and themes. We will focus on comparing research papers in medicine and technology. We aim to identify differences between the approaches to the subject, and to ultimately discover a possible synergy between the two fields. As an aside, it will be interesting to compare research papers sponsored by digital health companies to the work by independent researchers.

The published literature review will be used to inform a semi-structured interview guide. This qualitative approach will be used because the knowledge on technology-mediated practice is limited. Ten interview subjects will be identified. Ideally, these should all be clinically active physicians, with an expanded knowledge of digital technology. We will try to recruit interview subjects within a wide age-range and with equal gender distribution. Based on age and gender stereotypes, we expect that it will be easy to find younger, male subjects. In contrast, we believe it will be increasingly difficult to find older, female subjects. It may be necessary to have separate requirements for the different groups to be able to ensure adequate group diversity.

The group will be recruited through digital means, through e-mail registries of physicians and Facebook-groups dedicated to physicians interested in technology. Individual, semi-structured interviews of approximately an hour will be conducted by the author. Ideally, interviews should be conducted in person. Due to the COVID-19 pandemic, we might have to accept online video-interviews (Skype/Zoom/Phone). The interviews will be recorded and transcribed. The material will then be analysed through STC according to Malterud (26) in four steps:

  1. Materials will be read through three times to gain an overall impression.
  2. Units of meaning corresponding to the aim of the study will be manually identified, sorted, and systematically decontextualised, i.e., lifted out of context and matched with related text elements.
  3. The resulting code groups will be condensed into concrete content.
  4. Recontextualization is performed, i.e., the content in each code group will be described, summarised, and an analytical text with categories and subcategories is produced.

The recontextualised content will inform the discussion and conclusions of the study.

prosjektdeltakere

prosjektleder
Aktiv cristin-person

Damoun Nassehi

  • Tilknyttet:
    Prosjektleder
    ved Avdeling for omsorg og etikk ved Universitetet i Stavanger

Ellen Ramvi

  • Tilknyttet:
    Prosjektdeltaker
    ved Avdeling for omsorg og etikk ved Universitetet i Stavanger
Aktiv cristin-person

Birgitta Haga Gripsrud

  • Tilknyttet:
    Prosjektdeltaker
    ved Avdeling for omsorg og etikk ved Universitetet i Stavanger
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