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Cited by 120Telemedicine and Telehealth ImplementationPatient-Provider Communication in HealthcareHeart Failure Treatment and Management

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

Open access
Seuren, Lucas Martinus, Wherton, Joseph, Greenhalgh, Trisha, Cameron, Deborah, A'Court, Christine, Shaw, Sara E·2020·Journal of Medical Internet Research
DOI 10.2196/16694PMC PMC7059096

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Abstract

Background: 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. Objective: This study aimed to explore the opportunities and challenges of remote physical examination of patients with heart failure using video-mediated communication technology. Methods: 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. Results: 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 of the adequacy of the examination and the trustworthiness of the data. In sum, despite significant challenges, selected participants in heart failure consultations managed to successfully complete video examinations. Conclusions: Video examinations are possible in the context of heart failure services. However, they are limited, time consuming, and challenging for all involved. Guidance and training are needed to support rollout of this new service model, along with research to understand if the challenges identified are relevant to different patients and conditions and how they can be successfully negotiated.

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  • As a result of device and instruction difficulties, the accuracy and quality of the diagnostic examination can be inconsistent.

    “As a result, the accuracy and quality of the diagnostic examination can be inconsistent [246].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [246]

  • Voice assistants show potential for health and care support for shared devices, including shared use that facilitates care for families with mixed visual ability, stroke survivors, and people living with Parkinson's.

    “However, VAs show much potential for health and care support for shared devices, including the shared use of voice assistants that facilitate care, for example amongst families with mixed visual ability [80] stroke survivors [2] compensating for physical and cognitive impairments and people living with Parkinson's [24].”

    From Amazon Echo Show as a Multimodal Human-to-Human Care Support Tool within Self-Isolating Older UK Households (2022) · cites this paper as [80]

    The Results (Challenge 3) and Conclusions discuss video examinations for patients with heart failure, sometimes assisted by relatives. A search for Parkinson’s disease and voice assistants found no passage addressing their shared use or care support for people living with Parkinson’s—the part of the sentence attached to this citation. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Missed or mismanaged healthcare tasks, such as taking medication, can lead to safety risks if the device does not inclusively support users or fails for other reasons.

    “Missed or mismanaged healthcare tasks, such as taking medication, can lead to safety risks if the device does not inclusively support users (or fails for other reasons e.g. where there is no habit formed by a person with their medication and over-reliance is placed on the device's use [79]).”

    From Amazon Echo Show as a Multimodal Human-to-Human Care Support Tool within Self-Isolating Older UK Households (2022) · cites this paper as [79]

    The Results (Challenge 1; page unavailable) describe an incorrectly performed video examination that produced misleading oximeter readings. They do not address the point attached to citation [79]: medication habits, reliance on a device to take medication, or safety risks when that device fails. Searches for medication habits, reminders, and missed doses found no relevant passage. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Authors
Seuren, L. M., Wherton, J., Greenhalgh, T., Cameron, D., A'Court, C., & Shaw, S. E.
Affiliations
University of Oxford (GB)
Corresponding author
Seuren, Lucas Martinus
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2020-02-20
Volume
22
Issue
2
Pages
e16694
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/16694
PMC
PMC7059096
OpenAlex
W3008466924
Cited by
120
References
60
Citations by year
2026: 5 · 2025: 19 · 2024: 15 · 2023: 12 · 2022: 22 · 2021: 23 · 2020: 23 · 2018: 1
FWCI
15.66
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
  • Wellcome Trust (WT104830MA, 104830/Z/14/Z)
  • National Institute for Health and Care Research (BRC-1215–20008, 13/59/26, PB-PG-1216-20012, NIHR- BRC-1215-20008)
  • Department of Health and Social Care
  • NIHR Oxford Biomedical Research Centre (1215-20008, NIHR-BRC-1215–20008, BRC-1215-20008)
  • NIHR Sheffield Biomedical Research Centre
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
heart failure, remote physical examination, video consultation, telemedicine, lower limb edema, blood pressure measurement, oxygen saturation, patient autonomy, nurse-patient communication, nonverbal communication, video communication, technological literacy, clinical judgment, FaceTime
MeSH terms
Communication, Female, Heart Failure, Humans, Male, Physical Examination, Video Recording, Telemedicine, Qualitative Research

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