Qualitative Analysis of Remote Consultations (QuARC): A study of technology-enhanced consultations in diabetes, cancer and heart failure

Abstract

Background Remote video consulting is promoted by policymakers as a way of delivering healthcare efficiently to an ageing 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 aim of this study is to identify and analyse the communication strategies through which remote consultations are accomplished, and to produce guidance for patients and clinicians to improve the communicative quality of remote consultations. Methods In previous research we have collected and analysed two separate datasets of remote consultations in an NIHR-funded study of clinics in East London using SkypeTM and a Wellcome Trust-funded study of specialist community heart failure teams in Oxford, using SkypeTM or FacetimeTM. The QuARC (Qualitative Analysis of Remote Consultations) study will combine datasets and undertake detailed interactional micro-analysis of up to 40 remote consultations undertaken by senior and junior doctors and nurse specialists, consulting with adults with diabetes, women who have diabetes in pregnancy, people consulting for post-operative 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 (e.g. conversation analysis), analysis will examine the contextual features in remote consultations (e.g. restricted visual field), combined with close analysis of different modes of communication (e.g. speech, gesture, gaze). Results 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 since roll out of remote consultations is planned across the NHS.