Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study)
Open accessAbstract
BACKGROUND: Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. OBJECTIVE: Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. METHODS: We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. RESULTS: Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can improve trust. The clinical teams studied had not themselves formally evaluated the impact of their intervention. Staff time is the main cost driver, but offsetting savings are likely elsewhere in the health service. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information, and communication failures, which are mostly mitigated by young people and clinicians using common-sense approaches. CONCLUSIONS: As NHS policy prompts more widespread use of digital communication to improve the health care experience, our findings suggest that benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team, and where there is identifiable need for patients to have flexible access, such as when transitioning between services, treatments, or lived context. Clinical teams need a proactive approach to ethics, governance, and patient safety.
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The potential for misunderstandings in written digital communication was recognized by clinicians, particularly for diabetes and young individuals with long-term conditions.
“The potential for misunderstandings in written digital communication was also recognized by clinicians, particularly for diabetes and young individuals with long-term conditions [88,89].”
From Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review (2024) · cites this paper as [89]
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- Authors
- Griffiths, F., Bryce, C., Cave, J., Dritsaki, M., Fraser, J., Hamilton, K., Huxley, C., Ignatowicz, A., Kim, S. W., Kimani, P. K., Madan, J., Slowther, A.-M., Sujan, M., & Sturt, J.
- Affiliations
- University of the Witwatersrand (ZA)
- University of Warwick (GB)
- University of Oxford (GB)
- King's College London (GB)
- Corresponding author
- Griffiths, Frances
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2017-04-10
- Volume
- 19
- Issue
- 4
- Pages
- e102
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5404145
- OpenAlex
- W2607508981
- Cited by
- 85
- References
- 47
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 5 · 2021: 30 · 2020: 10 · 2019: 8 · 2018: 12 · 2017: 2
- FWCI
- 14.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- DMU Open Research Archive (De Montfort University) (submittedVersion)
- Funders
- National Institute for Health and Care Research (12/209/51)
- Health Services and Delivery Research Programme (12/209/51)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Keywords
- youth, chronic disease, patient engagement, National Health Service, therapeutic relationship, patient autonomy, health care costs, information governance, confidentiality, trust, mobile phone calls, text messaging, email, Voice over Internet Protocol, patient activation, mental illness, physical health conditions, patient-clinician communication
- MeSH terms
- Adolescent, Adult, Communication, Delivery of Health Care, Health Services, Humans, Telemedicine, Internet, Young Adult
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