Impact of digital health on the patient-provider relationship in respiratory secondary care settings: a mixed methods systematic review from IHI DRAGON/CONNECT CRC

Patients and providers have expressed concerns about how digital care affects their relationship. We systematically reviewed the evidence on how digital health affects the patient-provider relationship. <bold>Methods:</bold> We searched 7 databases (date-Nov 2023) using terms for respiratory, digital health and patient-provider relationship (in secondary care). 38 volunteers from ELF, DRAGON and CONNECT undertook duplicate screening/data extraction. Analysis was thematic. <bold>Results:</bold> Of 116 included studies, 32 explicitly explored the patient-provider relationship. Existing frameworks for patient-provider relationships (Ridd) proved only partially applicable. Trust was foundational and depended on providers’ beliefs about the technology. It was obstructed if clinicians expressed fear and scepticism. Care was demonstrated through monitoring which created an emotional presence, making patients feel taken care of. Connection between the patient/provider was enhanced if communication was seamless, but burdensome technology could create a disconnect due to disengagement. Shared decision-making enhanced by self-monitoring devices changed the dynamics and created a more equal patient-doctor relationship, through improved self-efficacy, and empowerment. <bold>Conclusion:</bold> Digital care is widely used post-COVID [as shown in DRAGON IHI], however, the impact on the patient/provider relationship is still under-researched. Seamless connection, and strategies to increase trust (both in the technology and in clinician support) are important considerations for strengthening the relationship. These findings will inform the work of CONNECT CRC.