Professor Deborah Cameron: List of publications

<sec> <title>BACKGROUND</title> <p>Video consultations are increasingly seen as a possible replacement for face-to-face consultations. Direct physical examination of the patient is impossible, but a limited examination may be undertaken via video (e.g. using visual signals, or asking a patient to press their lower legs and assess fluid retention). Little is currently known about what such video examinations involve.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To explore the opportunities and challenges of remote physical examination with patients with heart failure using video-mediated communication technology.</p> </sec> <sec> <title>METHODS</title> <p>Seven video consultations (using FaceTime) between patients with heart failure and their community-based specialist nurses were video-recorded with consent. We used conversation analysis to identify the challenges of remote physical examination over video and the verbal and non-verbal communication strategies used to address them.</p> </sec> <sec> <title>RESULTS</title> <p>Apart from a general visual overview, remote physical examination in heart failure patients was restricted to assessing fluid retention (by the patient or relative feeling for leg oedema), blood pressure and pulse rate and rhythm (using a self-inflating blood pressure monitor incorporating an irregular heart beat indicator, and put on by the patient or relative-) and oxygen saturation (using a finger clip device). In all seven cases, one or more of these examinations were accomplished via video, generating accurate biometric data for assessment by the clinician. However, video examinations proved challenging for all involved. Participants (patients, clinicians and, sometimes, relatives) needed to collaboratively negotiate three recurrent challenges: (i) adequate design of instructions to guide video examinations (with nurses required to explain tasks using lay language, and checking instructions were followed); (ii) accommodation of the patient’s desire for autonomy (on the part of nurses and relatives) in light of opportunities for involvement in their own physical assessment; and (iii) doing the physical examination while simultaneously making it visible to the nurse (with patients and relatives needing adequate technological knowledge in order to operate a device and make the examination visible to the nurse, as well as basic biomedical knowledge to follow nurses’ instructions). Nurses remained responsible for making a clinical judgment of the adequacy of the examination and the trustworthiness of the data. In sum, despite significant challenges, selected participants in heart failure consultations managed to successfully complete video examinations.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Video examinations are possible in the context of heart failure services. However, they are limited, time-consuming and challenging for all involved. Guidance and training are needed to support roll out of this new service model, along with research to understand if the challenges identified are relevant to different patients and conditions and how they can be successfully negotiated.</p> </sec>

<sec> <title>BACKGROUND</title> <p>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.</p> </sec> <sec> <title>OBJECTIVE</title> <p>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.</p> </sec> <sec> <title>METHODS</title> <p>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).</p> </sec> <sec> <title>RESULTS</title> <p>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.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>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.</p> </sec> <sec> <title>REGISTERED REPORT IDENTIFIER</title> <p>RR1-10.2196/10913</p> </sec>

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