Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 8, 2025
Date Accepted: Mar 28, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of digital health on the patient-provider relationship in respiratory secondary care settings: a mixed methods systematic review
ABSTRACT
Background:
Digital health technology adoption has accelerated in respiratory care, particularly since COVID-19, supporting various applications from self-management to telerehabilitation. While these technologies transform healthcare delivery, their impact on the patient-provider relationship in specialist respiratory care remains poorly understood.
Objective:
To systematically review the literature on the impact of digital health technology on the patient-provider relationship in respiratory secondary care settings and to understand the factors that enhance or diminish this relationship.
Methods:
We conducted a systematic review following Cochrane methodology, searching MEDLINE, Embase, CINAHL, Cochrane databases, and PsycINFO in December 2023. We included qualitative, quantitative, and mixed-methods studies examining digital health interventions in respiratory secondary care. Screening and data extraction were performed by trained volunteers from the European Respiratory Society CONNECT Clinical Research Collaboration. We conducted a qualitative meta-synthesis of findings, followed by an abductive analysis of quantitative data. Three stakeholder workshops were held to interpret findings collaboratively with patients and healthcare professionals.
Results:
From 15,779 papers screened, 98 met inclusion criteria (56 qualitative/mixed-methods, 42 quantitative). Studies covered various respiratory conditions including COPD (32%), asthma (26%), and COVID-19 (13%). Four main themes emerged: trust (foundational to the relationship), adoption factors (clinical context and implementation drivers), confidence in technology (functionality and evidence base), and connection (communication and caring presence). Digital health technology could either enhance or diminish trust between patients and clinicians, with patients' perceptions of implementation motivations being crucial. While technology facilitated access and communication, remote consultations risked depersonalisation, particularly when not balanced with in-person interactions. Self-monitoring and information access empowered patients and promoted more equal patient-provider relationships.
Conclusions:
Digital health technology can either strengthen or weaken patient-provider relationships in respiratory care, with effects mediated through adoption factors, confidence in technology, connection, and patient empowerment. Maintaining trust in the era of digital care requires transparent implementation motivations, consideration of individual circumstances, and reliable technology that supports rather than replaces the therapeutic relationship.
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