JMIR Publications

ABSTRACT

Background:

Informal carers play an important role in the everyday care of patients and the delivery of healthcare services. They help patients get to and from appointments, and they assist during the appointments (e.g., answering questions on the patient’s behalf, asking questions about managing the patient’s health and illness). Video consultations are often seen as a way of providing patients easier access to care. However, few studies have considered how this affects the role of informal carers, and how they are needed to make video consultations feasible, safe, and effective.

Objective:

This study aimed to identify how informal carers, usually friends or family who provide unpaid support, support patients and clinicians during video consultations.

Methods:

We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 NHS Trusts in the UK National Health Service. The data set consisted of 52 video-recordings of video consultations (in diabetes, gestational diabetes, cancer, heart failure, orthopaedics, long-term pain, and neuromuscular rehabilitation), and interviewed all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and non-verbal communication in the context of the interaction, we examined the interactional, technological and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context.

Results:

Most patients conducted the video consultation without support from an informal carer. Only 12 of 52 consultations involved an informal carer. In addition to facilitating the clinical interaction (e.g., answering questions on behalf of the patient), we identified three types of “work” that informal carers did, they (1) facilitated the use of technology, (2) addressed problems when the patient did not hear or understand the clinician, and (3) assisted with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, co-present carers provided patients with reassurance and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all challenges of a video consultation (e.g., aiming the camera while laying hands on the patient during an examination). We compared with cases where an informal carer was not co-present, which showed that carers provided an important safety net, particularly for frail patients who experience mobility difficulties.

Conclusions:

Most patients conducted the video consultation without support from an informal carer. Only 12 of 52 consultations involved an informal carer. In addition to facilitating the clinical interaction (e.g., answering questions on behalf of the patient), we identified three types of “work” that informal carers did, they (1) facilitated the use of technology, (2) addressed problems when the patient did not hear or understand the clinician, and (3) assisted with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, co-present carers provided patients with reassurance and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all challenges of a video consultation (e.g., aiming the camera while laying hands on the patient during an examination). We compared with cases where an informal carer was not co-present, which showed that carers provided an important safety net, particularly for frail patients who experience mobility difficulties.