Interactional analyses have increasingly, and fruitfully, been applied to the communication of healthcare workers and their patients. But there are ethical risks and dangers, given the sensitivity of the issues involved. Marco Pino and Ruth Parry have kindly offered their reflections on how to handle the difficulties, and to come out with data that are as ethically sound as they are analytically useful.
More than two years ago I was employed to work with Ruth Parry on a conversation analytic study on communication in end of life care.
One of the first steps was to apply for ethical approval, which had to be provided by an NHS ethics committee. This was also my very first job in the UK – I was taken aback by all the daunting stories I was starting to hear about how difficult it was to obtain ethical approval to do research within the NHS.
The initial sense of despair was exacerbated by the fact that ethics committees were (and are) still largely unfamiliar with – and often suspicious of – video recording as a data collection technique, as opposed to interviews, for instance. Video recording raises a number of concerns including threats to confidentiality and the risk of altering the very communication we are aiming to analyse.
To build a persuasive case that our research was worthwhile and safe, Ruth had already started to build a substantial collection of papers and documents on video recording for research purposes. These were a bunch of heterogeneous publications ranging from studies that had sought to establish the acceptability and the effects of video recording, guidelines recommending how to carry out video research, and more theoretical contributions to the ethical issues involved in video recording for research purposes.
Systematising what’s already known
We started systematising and synthesising this literature in order to distil from it a core set of best practices for designing ethically sound video-based research protocols. This exercise was very useful and fed into our ethics application which – I am happy to say – passed the scrutiny of the ethics committee. Later, Ruth and I decided to make the findings of this literature review available to other researchers doing video-based research on healthcare communication; therefore, we wrote it up (with our medical colleagues) as a paper, which has been recently published in Patient Education and Counseling.
Our paper identifies three areas of concern associated with video research:
- coercing people into being recorded,
- affecting the communication amongst them, and
- compromising their anonymity and confidentiality.
We propose that these concerns are valid and should be taken seriously when designing a study protocol; at the same time, the available evidence suggests that they do not provide a sufficient basis for rejecting ethics applications to conduct video based research, on condition that adequate measures are built into the research protocol to protect participants’ safety and autonomy.
How to minimise the risks?
The paper discusses how the risks associated with video based research can be minimised (although not fully eliminated); it also contains detailed recommendations on how to do so. We emphasise that our recommendations cannot be used as a recipe but should be adapted to the specifics of each setting in which video based research has to be conducted. It seems to us that video research calls for situated ethical judgment – crucial decisions depend on:
- type of setting,
- patient populations,
- activities being recorded, and
- the intended uses of the data.
Our recommendations provide a framework in which these matters can be systematically considered and addressed.
We need video!
High quality video recordings are at the essential ingredient for rigorous research on human interaction – we hope that our recommendations will help researchers around the world design ethically sound research protocols and build persuasive cases about the importance and acceptability of video recording to better understand communication in healthcare.