How telemonitoring impacts the responsibilities of patients and healthcare professionals in cardiology: A Q-methodology study.

OBJECTIVE

Telemonitoring is widely used in cardiology but raises questions about the impact on roles and responsibilities for patients and caregivers. This study explores this using a Dutch cardiology telemonitoring program.

METHODS

Q-methodology was employed, combining quantitative and qualitative data from semi-structured interviews. Participants ranked statements on caregiver and patient roles and responsibilities in telemonitoring and explained their rankings. By-person factor analysis was used to identify clusters in the statement rankings. These factors were interpreted using interview data.

RESULTS

Thirty participants revealed four viewpoints on roles and responsibilities in telemonitoring: (1) Balancing Act, (2) From Clinical Observers to Remote Monitors, (3) Isolated Responsibility, and (4) Responsible but not Alone. All viewpoints agree on three aspects: patients are responsible for taking and submitting accurate measurements, that nurses' roles are shifting, and that technology developers are accountable for device reliability while caregivers are responsible for data-usage in decision-making. Disagreements between viewpoints remain on four aspects: the extent of patients' responsibility regarding understanding measurements and alarming caregivers, changes in nurses' decision-making responsibilities, and how caregiving responsibilities are shared.

CONCLUSION

Ambiguity about responsibilities create practical and ethical challenges, including increased workload for nurses, lack of overview among cardiologists, anxiety in patients, and inconsistent care delivery. Unrecognized or unaddressed differences in views about roles and responsibilities using telemonitoring can negatively affect patient care. Appropriate implementation and use of telemonitoring requires sound ethical prologue and dialogue, not only to sensitize stakeholders about differing interpretations of responsibility, but also to ensure a structured approach when implementing telemonitoring to support best care.