Ethical considerations of digital health technology in older adult care

Clinician and Patient Perspectives on a Patient-Facing Online Breast Cancer Symptom Visualization Tool

PURPOSE

Endocrine treatments for patients with hormone-sensitive breast cancer are associated with significant side effects that can negatively affect health-related quality of life and result in treatment discontinuation. The objective of this qualitative study was to obtain feedback from stakeholder clinicians and patients about an online interactive tool that was designed to provide information and visualizations of breast cancer symptoms.

METHODS

The online Breast Cancer Symptom Explorer tool was developed to allow patients to visualize trajectories for common symptoms associated with tamoxifen and anastrozole using symptom data from the NSABP B35 breast cancer clinical trial. To refine the tool, virtual focus groups were conducted among oncology clinicians and women with a history of breast cancer who had received treatment with an aromatase inhibitor or tamoxifen, seeking feedback on the tool and its potential usefulness. Discussions took place using a secure web-conferencing platform following a semi-structured interview guide. Focus groups were audio-recorded, transcribed, and analyzed using reflexive thematic analysis.

RESULTS

Nine focus groups were conducted (n = 21 participants: eight clinicians and 13 patients). Key benefits and barriers to tool use emerged from the discussions. Both patients and oncologists valued the ability to engage with the tool and visualize symptoms over time. They indicated that ideal settings for its use would be at home before treatment initiation. Combinations of graphical representations with text were perceived to be most effective in communicating symptoms. Key barriers identified included concerns about accessibility to the tool and digital literacy, with recommendations to simplify the text and provide health literacy support to enhance its clinical utility in the future.

CONCLUSION

Clinician and patient involvement was critical for refinement of the breast cancer symptom explorer and provided insights into its future use and evaluation of the tool in clinical decision making.

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient-provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.

Factors affecting the adoption of metaverse in healthcare: The moderating role of digital division, and meta-culture

This research aims to find out the factors affecting the adoption of Metaverse in healthcare. This study explores the effect of perceived ease of use, perceived usefulness, and trust on adopting Metaverse in healthcare by keeping digital division and metaculture as moderating variables. The philosophical foundation is rooted in the positivism paradigm, the methodology is quantitative, and the approach used is deductive. Data was collected in Pakistan and China through judgmental sampling from 384 respondents. Partial Least Square Structural Equation Modelling (PLS-SEM) was used to analyze the collected data. The findings validate the relationship between perceived ease of use and the adoption of metaverse with β-value 0.236, t-value 5.207 and p-value 0.000, the relationship between perceived usefulness and the adoption of metaverse with β-value 0.233, t-value 4.017 and p-value 0.000, and the relationship between trust and adoption of a metaverse with β-value 0.192, t-value 3.589 and p-value 0.000. Results also show that the digital divide moderates the relation between perceived ease of use and adopting the metaverse having β-value 0.078, t-value 1.848 and p-value 0.032. Similarly, the findings also show that the digital divide does not moderate the relationships of perceived usefulness and trust with adopting the metaverse. Moreover, the meta culture also does not moderate the relationships of perceived ease of use, usefulness, and trust with adopting the metaverse. The study contributes to theoretical research on adopting a metaverse in healthcare by examining various factors necessary for its development. It also provides guidelines for the developers and adopters of suitable metaverse technology.

Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence (BN, KKQ), and ethics of advanced technologies (KKQ). The target audience for this article includes developers, manufacturers, and researchers of prosthetic devices and related technology. We present several ethical considerations for current advances in prosthetic technology, as well as topics for future research, that may inform product and policy decisions and positively influence the lives of those who can benefit from advances in prosthetic technology.

Digital health implementation in Australia: A scientometric review of the research

Objective

Australia is committed to establishing a digitally enabled healthcare system that fosters innovation, strengthens data capabilities, and establishes a foundation for future digital health reform. This study provides a comprehensive overview of digital health implementation research in Australia, employing scientometric analysis and data visualization. We assess the existing knowledge base, identify key research areas and frontier trends, and explore their implications for healthcare delivery in rural and remote settings.

Methods

A systematic search of the Web of Science Core Collection database was conducted for relevant documents up to December 31, 2023. Analysis of annual growth patterns, journals, institutional and authorship contributions, reference co-citation patterns, and keyword co-occurrence was conducted using scientometrics to create outputs in the form of graphs and tables. Evolutionary analyses were undertaken to delineate the current knowledge base, predominant research themes, and frontier trends in the field.

Results

A total of 196 documents related to digital health implementation in Australia were identified, demonstrating sustained growth since 2019. The evolution of the field is characterized by four distinct phases, with a pronounced focus on telehealth, particularly in the context of the COVID-19 pandemic. 'Remote health' emerged as a significant area of contemporary interest.

Conclusions

This scientometric study contributes to our understanding of digital health implementation research in Australia. Despite a considerable body of research, there remains a relative paucity of studies focused on implementation in underserved rural and remote areas which arguably stand to benefit the most from digital health advancements. Continued research in this field is crucial to ensure equitable access to the benefits offered by digital health innovations.