Home and Community Care Digest
Methods: The authors searched several medical databases for original research articles reporting use of technology based interventions delivered to older adults in their homes with varying health conditions. Based on several different reported tools, a list of 11 standards and ethical issues was used to assess articles. These items included: approval from research ethics boards, obtainment of informed consent, capacity of participants to consent, inclusion of cognitively impaired participants, use of professional standards for ethical practice, use of research ethical codes, use of incentives or honorarium for participants, confidentiality/protection of privacy/security, liability and/or legal issues, mechanism for monitoring participants, and mechanism for participants to contact the health provider.
Findings: After searching the literature, the authors reviewed a total of 107 journal articles. Most studies were conducted in North America (70%) and Europe (20%). While many conditions were investigated, chronic conditions (e.g., chronic heart failure, cancer, diabetes, and hypertension) were most often reported, representing 60% of the articles.
Of the standards and ethics issues examined, the average number reported in the articles was three. Eight articles failed to report on any of the ethical issues. Most articles reported using fewer than three of the five safeguards typically used to protect client privacy and information when using the Internet to provide services (i.e., use of password, securing of data, encryption, back-up storage systems, and firewalls). The majority of studies (70%) did not report using any safeguards.
Conclusions: Issues about professional practice standards and research ethics are not well documented in studies of technology-based health care programs delivered to older people in their homes. Health care providers and patients should be concerned with the lack of professional practice standards or code of ethics for guiding clinical practice in technology-based environments. Patients have the right to know that the services they receive in a technology-based environment meet the highest professional standards of care. Because patients may experience challenges in using technology to assist in monitoring their own health and insuring their safety, patients must be able to contact a health care provider at any time. Additional caution is needed to ensure protection of older adults who may be especially vulnerable when receiving technology-based services in their homes. Ethics guidelines and professional standards and codes of conduct must be updated and/or developed to address specifically the delivery of healthcare using new technological innovations.
Reference: Marziali E, Dergal Serafini JM, McCleary L. "A systematic review of practice standards and research ethics in technology-based home health care intervention programs for older adults". Journal of Aging and Health, 2005; 17 (6), 679-696.
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