Safeguarding patients from technology-facilitated abuse in clinical settings: A narrative review

Abstract

Safeguarding vulnerable patients is a key responsibility of healthcare professionals. Yet, existing clinical and patient management protocols are outdated as they do not address the emerging threats of technology-facilitated abuse. The latter describes the misuse of digital systems such as smartphones or other Internet-connected devices to monitor, control and intimidate individuals. The lack of attention given to how technology-facilitated abuse may affect patients in their lives, can result in clinicians failing to protect vulnerable patients and may affect their care in several unexpected ways. We attempt to address this gap by evaluating the literature that is available to healthcare practitioners working with patients impacted by digitally enabled forms of harm. A literature search was carried out between September 2021 and January 2022, in which three academic databases were probed using strings of relevant search terms, returning a total of 59 articles for full text review. The articles were appraised according to three criteria: (a) the focus on technology-facilitated abuse; (b) the relevance to clinical settings; and (c) the role of healthcare practitioners in safeguarding. Of the 59 articles, 17 articles met at least one criterion and only one article met all three criteria. We drew additional information from the grey literature to identify areas for improvement in medical settings and at-risk patient groups. Technology-facilitated abuse concerns healthcare professionals from the point of consultation to the point of discharge, as a result clinicians need to be equipped with the tools to identify and address these harms at any stage of the patient’s journey. In this article, we offer recommendations for further research within different medical subspecialities and highlight areas requiring policy development in clinical environments.

Simulation-based research for digital health pathologies: A multi-site mixed-methods study

“…In discussions of TFA, participants raised concerns that some patients may be more at risk including patients with dementia who may be subject to elder abuse and young people at risk of knife crime and gang violence. 36 – 39 Participants also shared concerns about the RFID chip technology that could be imposed on groups without consent, and given the increased investment in smart implant technologies with growing functional capabilities, these may hold significant threats to privacy and bodily autonomy in the future.…”

“…For consumer technology, we focus on the potential implications of smart implants, and the patient safety implications of tracking devices that have been described in cases of technology-facilitated abuse (TFA). 36 – 39 Across the four clinical simulation scenarios defined below, we explore the barriers to effective patient care, identify the key challenges faced by clinicians, and explore opportunities for improving future clinical care and ensuring the safe implementation of digital health innovations.…”

21st century medicine and emerging biotechnological syndromes: a cross- disciplinary systematic review of novel patient presentations in the age of technology

“…Patient's with higher body habitus may be at increased risk of device failures, as suggested by Katsaras et al who consider the impact of body habitus on loss of telemetric device function in their 63F pacemaker-dependant patient (75). Women and girls face additional risks, particular regarding technology-facilitated abuse and psychiatric misdiagnosis (25,(76)(77)(78)(79).…”

Developing technology-based interventions for infectious diseases: ethical considerations for young sexual and gender minority people

“…Regulatory limitations also underscore the potential for harm in rapid TBI development and implementation. YSGM people, given their increased vulnerability in healthcare settings relative to heterosexual and cisgender people ( 35 ), require extra care to reduce the potential of “technology-facilitated abuse” ( 36 )—that is, the harm that derives from TBIs with poor validity, accuracy, safety, and scientific rigor. Even if a local jurisdiction does not require extensive effectiveness evidence, we charge TBI developers and providers to implement TBIs with YSGM people if and only if: (a) the TBI is technologically stable, has high fidelity, and yields clinically meaningful results ( 37 ); (b) implementation stakeholders are educated on the scientific evidence behind the TBI; (c) the TBI has a robust monitoring and evaluation plan ( 38 ); and (d) the TBI presents accurate claims of its effectiveness for YSGM people.…”