Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes (Preprint)

Abstract

BACKGROUND A telemedicine service for remote surgical guidance had shown teaching effects and impact on clinical practice during a highly specialized endoscopic procedure called ERCP. However, doctors’ interest in the innovation did not appear to correspond to the anticipated needs, and there was concern about how to make the practice an integrated and accepted way of working. OBJECTIVE In this study, the Technology Acceptance Model (TAM) is used as a conceptual framework to structure a qualitative investigation into endoscopic surgeons attitudes towards remote surgical guidance in ERCP, prior to its implementation. METHODS 20 semi-structured interviews were conducted with ERCP staff from 5 hospitals to elicit details about work practices, common challenges during procedures and factors contributing to performance during ERCP, as well as beliefs regarding the value of teleguidance. Theoretical constructs from TAM were used to guide the thematic analysis of the interviews. The findings from the interviews guided the preparation of test items for a questionnaire directed to a wider group of ERCP specialists. Descriptive statistics were employed to calculate mean scores and variance. In addition, results were dichotomized due to the small sample, in order to support comparison between groups. RESULTS In the interviews, practitioners described performance during ERCP as dependent on individual, team and and organisational factors. They weighed the value of teleguidance in terms of how it might affect both their individual performance but also how it might interact with the wider context. The questionnaire results from 23 respondents at 15 different ERCP clinics indicated a number of differences between novices’ and experts’ attitudes. Novices were generally positive towards the usefulness of teleguidance (69% giving a positive rating). While the experts also were generally positive (64 %), there was more variance in this group, and some respondents were consistently very negative. CONCLUSIONS The findings from the interviews and the questionnaire indicated that novices and experts weigh the value of teleguidance in different ways. Senior practitioners have less urgent needs for consultation and often have managerial functions, hence a different perspective of the changes that teleguidance might entail. As senior clinicians are more likely to be key decision makers, the attitudes among this group can have a greater relative importance for adoption than that of the novices. TAM can be seen as a valuable conceptual framework to help direct an investigation about acceptance of teleguidance. However, a TAM questionnaire can only capture a small portion of the factors affecting how a telemedicine service in complex and collaborative clinical work can come to be adopted. CLINICALTRIAL Swedish Ethical Review Authority 2014/859-31