Telehealth Beyond the Pandemic: The Human Work of Primary Healthcare Communication, Relationships, and the Value of the Human in Primary Care

Abstract

The COVID-19 pandemic moved primary care to the virtual environment essentially overnight, allowing the transactional aspects of healthcare to continue, but likely diluting the formation of patient-clinician trust that is central to primary care. Trusting relationships between patients and clinicians allows for human willingness to be vulnerable based on expectations beyond simply the professional competence of measuring symptoms. Trust is thought to be an effective tool to reduce the overuse of health care services, but the development and maintenance of trusting relationships in a virtual environment is not well understood. In fact, emerging research suggests that virtual care potentiates overuse and often results in missed human cues and patient concerns. This project brings together researchers from Communication (Ashley Duggan, MCAS), nursing health services (Monica O’Reilly-Jacob, CSON), evidence-based medicine (Allen Shaughnessy, Tufts University School of Medicine) and bioethics (Andrea Vicini, SJ, MCAS) to explore the development and maintenance of patient-clinician trust in virtual primary care and the unintended consequences of the overuse of health care services. From the Schiller grant we will produce two scholarly papers and develop foundations for theoretical frameworks and organizational structures for working together. The first paper will address trust in telehealth, with a particular focus on its effect on unnecessary healthcare utilization. The second paper will address relationship processes and missed cues in telehealth.  

Presentations

• Written Reflections Indicative of Trust: Implications for Telemedicine and Relational Trust, Presentation at the 50th North America Primary Care Research Group, November 2022
• ‘Don’t Worry, You Can Trust Me:’ Indicators of the Role of Trust in Residents’  Reflective Writing, 20th International Conference on Communication in Healthcare (ICCH), September 2022
• Digital Health Alongside Human Connection: Initial Results of RCSI’s Coach Connect Platform, 20th International Conference on Communication in Healthcare (ICCH), September 2022
• Telemedicine beyond the Pandemic: The Human Work of Primary Healthcare, International Communication Association post conference in digital health, May 2022
  

Publications 

• O’Reilly-Jacob, M., Vicini, SJ, A., & Duggan, A. (2022) “Ethical Considerations of Telehealth: Access,Inequity, Trust, and Overuse,” Journal of Health Ethics 18, no. 1. 
• Vicini, SJ, A., Duggan, A., & Shaughnessy, A. (In Press). Theory Building as Integrated Reflection: Understanding Physician Reflection Through Human Communication Research, Medical Education, and Ethics. In Press in Journal of Health Ethics. 
• Shaughnessy, A.F., Vicini, SJ, A., Zgurzynski, M. et al. Indicators of the dimensions of trust (and mistrust) in early primary care practice: a qualitative study. BMC Prim. Care 24, 150 (2023). 
  

Additional Grants

• American Nurses’ Foundation ($1,065,000)
  

Additional Accomplishments 

• Fulbright at Royal College of Surgeons received (Duggan)
• O'Reilly-Jacob left BC and became part of a team at Columbia University School of Nursing in their Center for Healthcare Delivery and Innovations focused exclusively on health services and primary care outcomes. She was inducted into the American Academy of Nursing.
• Ashley Duggan completed her Fulbright at the Center for Positive Health Sciences where she connected relationship science and positive health sciences and built an international, interdisciplinary team from her leadership with this SIGECS grant.