Clinician behaviors in telehealth care delivery: a systematic review

Abstract

Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider–patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider–patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.

Appendices

Appendix 1: CINAHL complete

Concept	Concept list
Telehealth	(MH “Telemedicine”) OR (MH “Telepsychiatry”) OR (MH “Telehealth”)
Education	(MH “Nursing Skills”) OR (MH “Communication Skills Training”) OR (MH “Social Skills Training”) OR (MH “Social Skills”) OR (MH “Communication Skills”) OR (MH “Skill Acquisition”) OR (MH “Skill Retention”) OR (MH “Competency Assessment”) OR (MH “Clinical Competence”) OR (MH “Job Characteristics”) OR (MH “Defining Characteristics (NANDA)”) OR “characteristics” OR (MH “International Organization for Standardization”) OR (MH “American National Standards Institute”) OR “standards” (MH “Practice Acts”) OR “best practices” OR (MH “Patient Bedside”) OR (MH “Nursing as an Art”))

Appendix 2: PubMed

Concept	Concept list
Telehealth	“Telemedicine”[Mesh] OR “Remote Consultation”[Mesh] OR “communication technology” OR telehealth OR telepsychiatry
Education	((“Inservice Training”[Mesh] OR “Teaching”[Mesh] OR “Schools, Nursing”[Mesh] OR “Staff Development”[Mesh] OR training OR “Education”[Mesh] OR “education”[Subheading] OR “Nursing Education Research”[Mesh]) AND (“Health Personnel”[Mesh] OR “Caregivers”[Mesh] OR “Physicians”[Mesh] OR “Physicians, Primary Care”[Mesh] OR “Physician Assistants”[Mesh] OR “Osteopathic Physicians”[Mesh] OR “Occupational Health Physicians”[Mesh] OR “Physician’s Role”[Mesh] OR “Medical Staff, Hospital”[Mesh] OR “General Practitioners”[Mesh] OR “Professional Competence”[Mesh] OR “Clinical Competence”[Mesh]))

Appendix 3: Proquest dissertations

Concept	Concept list
Telehealth	(health OR psychiatry OR medicine)
Education	(“Nursing Skills” OR “Communication Skills Training” OR “Social Skills Training” OR “Social Skills” “Communication Skills” OR “Skill Acquisition” OR “Skill Retention” OR “Competency Assessment” OR “Clinical Competence” OR “Job Characteristics” OR “Defining Characteristics “ OR characteristics OR “International Organization for Standardization” OR “American National Standards Institute” OR standards OR “Practice Acts” OR “best practices” OR “Patient Bedside” OR “Nursing as an Art”) AND all((telehealth OR telepsychiatry OR telemedicine OR telecommunications))

Appendix 4: ERIC

Because the database did not offer TELEHEALTH or TELEMEDICINE as actual terms in the thesaurus, we were required us to parse out TELEHEALTH to two ideas into communications and health delivery.

Concept	Concept list
Telehealth	(DE “Communications” OR DE “Communicative Competence (Languages)” OR DE “Telecommunications”)
Health care delivery	(DE “Health” OR DE “Nursing” OR DE “Nursing Education” OR DE “Nursing Students” OR DE “Health Sciences” OR DE “Health Services” OR DE “Health Personnel”)
Education	(DE “Professional Development” OR DE “Training” OR DE “Competence” OR DE “Competency Based Education” OR DE “Praxis”)

Appendix 5: PsychInfo

Because the database did not offer TELEHEALTH or TELEMEDICINE as actual terms in the thesaurus, we were required us to parse out TELEHEALTH to two ideas into communications and health delivery.

Concept	Concept list
Telehealth	Exp Communication Systems/or exp Information Technology/or exp Communication/or exp Telemedicine/or exp Online Therapy/or exp Teleconferencing/or exp Telecommunications Media/(221513)
Health care delivery	Exp Health Care Delivery/or exp Health Care Services/or exp Nursing/or exp Nurses/or exp Mental Health Services/or exp Health Personnel/or exp Health Care Utilization/or exp Mental Health/or exp Health/or exp Health Care Delivery/or exp Geriatric Psychiatry/or exp Social Psychiatry/or exp Consultation Liaison Psychiatry/or exp Adolescent Psychiatry/or exp Community Psychiatry/or exp Psychiatry/or exp Professional Consultation/(results 317244)
Education	Exp Education/or exp Competence/or exp Counselor Characteristics/or exp Clinical Psychology Graduate Training/or exp Self Instructional Training/or exp Social Skills Training/or exp Inservice Training/or exp Communication Skills Training/or exp Mental Health Inservice Training/or exp Personnel Training/or exp Community Mental Health Training/or exp On the Job Training/or exp Psychotherapy Training/or exp Human Relations Training/or exp Psychoanalytic Training/or exp Training/or exp Clinical Methods Training/or exp Professional Competence/(Results 261205)

Appendix 6: Hand searching

Journal titles
Health Communications
Health Management Technology
Journal of Continuing Education in the Health Professions
Journal of Telemedicine and Telecare
Telemedicine and E-health