More and more medical care can be provided remotely. This project identified factors that positively influence the trust that patients have in telecare innovations, and therefore their success.  

Doctor-patient trust is an important factor in the provision of good medical care. In the case of remote care – or telecare – the question is what the patient can base that trust on. The researchers described six factors that are important in ensuring that patients trust this form of care. The “well-founded trust framework” that was developed and the accompanying questionnaire can be used to assess telecare innovation projects.

The “well-founded trust framework” makes every actor in the telecare system responsible for providing patients with good reason to trust the system. This means that this also applies to service providers, software developers and support staff. The researchers identified six important factors:

1. personal recommendation/guarantee (for example by doctor)
2. general recommendation/guarantee (for example through certification)
3. presence of incentive to perform well (for example reputation system)
4. communication of shared values (risk that this can be seen as “window dressing”)
5. active role for user (for example providing user with options)
6. facilitate good user experience (for example option to contact helpdesk)

Well-founded trust

One problem with telecare is that the treating doctor and care facility are no longer able to guarantee the quality of the telecare services and systems. Patients used to be able to trust a doctor based on personal interaction, but telecare raises the issue as to what the patient can now base that trust on.

Unfortunately, telecare often fails when it comes to “well-founded trust”. For example, patients report that the relationship between the system that they use and the role of the treating doctor is unclear. Cases are also seen in which a patient receives a reminder to upload data and pay subscription fees, while there is no longer a treating doctor connected to the system.

This is a typical responsible innovation project, because it examined how the results could be implemented in policy and used in the responsible development of new telecare innovations. The research outcomes were an ethical framework – the “well-founded trust framework” – and a questionnaire. These can be used to evaluate telecare innovation projects.

Promise

Trust is an important value in medical science. This is expressed most clearly in the relationship between doctor and patient. A patient’s trust in his or her doctor is essential for ensuring good communication and important when making medical decisions.

However, telecare changes the doctor-patient relationship. Telecare promises to reduce healthcare costs and improve healthcare outcomes, but whether this can be achieved depends in part on the degree of trust that the patient has in the system.

As well as trust, the following ethical and societal aspects of telecare were also addressed in this project: accountability, privacy, legitimacy, autonomy, self-determination and independence. 

Research method

The researchers examined the process by which chronically ill patients come to trust telecare applications, and the point at which this trust is well-founded. This involved an ethical review of trust and its importance in healthcare as empirical research. This included interviews with patients, medical professionals and developers that work for two telecare companies (see box). A large database of patient questionnaire results was also analysed.

e-health, telemedicine, trust, ICT, ICT, health care, patient doctor relationship, communication, user, quality of care, long-distance care