Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis

• Published in: Journal of medical Internet research 2020-02, Vol.22 (2), p.e16694-e16694
• Main Authors: Seuren, Lucas Martinus, Wherton, Joseph, Greenhalgh, Trisha, Cameron, Deborah, A'Court, Christine, Shaw, Sara E
• Format: Article
• Language: English
• Subjects: Adequacy; Autonomy; Blood pressure; Challenges; Clinical decision making; Communication; Communication strategies; Communications technology; Credibility; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - pathology; Humans; Legs; Male; Nonverbal communication; Nurses; Original Paper; Oxygen; Patients; Physical Examination - methods; Physical examinations; Qualitative Research; Recurrent; Rhythm; Saturation; Telemedicine; Verbal communication; Video Recording - methods
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/16694

Video consultations are increasingly seen as a possible replacement for face-to-face consultations. Direct physical examination of the patient is impossible; however, a limited examination may be undertaken via video (eg, using visual signals or asking a patient to press their lower legs and assess fluid retention). Little is currently known about what such video examinations involve. This study aimed to explore the opportunities and challenges of remote physical examination of patients with heart failure using video-mediated communication technology. We conducted a microanalysis of video examinations using conversation analysis (CA), an established approach for studying the details of communication and interaction. In all, seven video consultations (using FaceTime) between patients with heart failure and their community-based specialist nurses were video recorded with consent. We used CA to identify the challenges of remote physical examination over video and the verbal and nonverbal communication strategies used to address them. Apart from a general visual overview, remote physical examination in patients with heart failure was restricted to assessing fluid retention (by the patient or relative feeling for leg edema), blood pressure with pulse rate and rhythm (using a self-inflating blood pressure monitor incorporating an irregular heartbeat indicator and put on by the patient or relative), and oxygen saturation (using a finger clip device). In all seven cases, one or more of these examinations were accomplished via video, generating accurate biometric data for assessment by the clinician. However, video examinations proved challenging for all involved. Participants (patients, clinicians, and, sometimes, relatives) needed to collaboratively negotiate three recurrent challenges: (1) adequate design of instructions to guide video examinations (with nurses required to explain tasks using lay language and to check instructions were followed), (2) accommodation of the patient's desire for autonomy (on the part of nurses and relatives) in light of opportunities for involvement in their own physical assessment, and (3) doing the physical examination while simultaneously making it visible to the nurse (with patients and relatives needing adequate technological knowledge to operate a device and make the examination visible to the nurse as well as basic biomedical knowledge to follow nurses' instructions). Nurses remained responsible for making a clinical judgment