糖尿病、癌症和心力衰竭领域的技术增强型会诊：远程会诊定性分析（QuARC）项目方案
Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project.
作者信息
Shaw Sara E, Cameron Deborah, Wherton Joseph, Seuren Lucas M, Vijayaraghavan Shanti, Bhattacharya Satyajit, A'Court Christine, Morris Joanne, Greenhalgh Trisha
机构信息
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Faculty of Linguistics, University of Oxford, Oxford, United Kingdom.
出版信息
JMIR Res Protoc. 2018 Jul 31;7(7):e10913. doi: 10.2196/10913.
BACKGROUND
Remote videoconsulting is promoted by policy makers as a way of delivering health care efficiently to an aging population with rising rates of chronic illness. As a radically new service model, it brings operational and interactional challenges in using digital technologies. In-depth research on this dynamic is needed before remote consultations are introduced more widely.
OBJECTIVE
The objective of this study will be to identify and analyze the communication strategies through which remote consultations are accomplished and to guide patients and clinicians to improve the communicative quality of remote consultations.
METHODS
In previous research, we collected and analyzed two separate datasets of remote consultations in a National Institute for Health Research-funded study of clinics in East London using Skype and a Wellcome Trust-funded study of specialist community heart failure teams in Oxford using Skype or FaceTime. The Qualitative Analysis of Remote Consultations (QuARC) study will combine datasets and undertake detailed interactional microanalysis of up to 40 remote consultations undertaken by senior and junior doctors and nurse specialists, including consultations with adults with diabetes, women who have diabetes during pregnancy, people consulting for postoperative cancer surgery and community-based patients having routine heart failure reviews along with up to 25 comparable face-to-face consultations. Drawing on established techniques (eg, conversation analysis), analysis will examine the contextual features in remote consultations (eg, restricted visual field) combined with close analysis of different modes of communication (eg, speech, gesture, and gaze).
RESULTS
Our findings will address the current gap in knowledge about how technology shapes the fine detail of communication in remote consultations. Alongside academic outputs, findings will inform the coproduction of information and guidance about communication strategies to support successful remote consultations.
CONCLUSIONS
Identifying the communication strategies through which remote consultations are accomplished and producing guidance for patients and clinicians about how to use this kind of technology successfully in consultations is an important and timely goal because roll out of remote consultations is planned across the National Health Service.
REGISTERED REPORT IDENTIFIER
RR1-10.2196/10913.
背景
政策制定者提倡远程视频会诊，认为这是一种为慢性病发病率不断上升的老龄人口高效提供医疗服务的方式。作为一种全新的服务模式，它在数字技术的使用方面带来了操作和互动方面的挑战。在更广泛引入远程会诊之前，需要对这一动态过程进行深入研究。
目的
本研究的目的是识别和分析远程会诊得以实现的沟通策略，并指导患者和临床医生提高远程会诊的沟通质量。
方法
在之前的研究中，我们在两项研究中收集并分析了两个独立的远程会诊数据集。一项是由英国国家卫生研究院资助的针对东伦敦诊所的研究，使用Skype进行远程会诊；另一项是由惠康信托基金会资助的针对牛津社区心力衰竭专科团队的研究，使用Skype或FaceTime进行远程会诊。远程会诊定性分析（QuARC）研究将合并这些数据集，并对资深和初级医生以及护士专家进行的多达40次远程会诊进行详细的互动微观分析，包括与成年糖尿病患者、孕期糖尿病女性、术后癌症手术咨询患者以及接受常规心力衰竭复查的社区患者的会诊，同时还有多达25次可比的面对面会诊。利用既定技术（如会话分析），分析将考察远程会诊中的情境特征（如视野受限），并结合对不同沟通模式（如言语、手势和眼神）的细致分析。
结果
我们的研究结果将填补目前关于技术如何塑造远程会诊中沟通细节的知识空白。除学术成果外，研究结果还将为共同制定有关沟通策略的信息和指导提供依据，以支持成功的远程会诊。
结论
识别远程会诊得以实现的沟通策略，并为患者和临床医生提供如何在会诊中成功使用此类技术的指导，是一个重要且及时的目标，因为英国国民医疗服务体系计划全面推广远程会诊。
注册报告标识符
RR1-10.2196/10913
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