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Studying Video Consultations: How do we record data ethically during COVID-19?

Lockdown in many countries has affected the way in which healthcare workers interact with their patients. In the UK, for example, a number of medical consultations have gone online, with doctors trying to deal with their patients over Zoom or Skype – and it has not been easy. Lucas Seuren has been working in Oxford in a team actively exploring the costs and benefits of online medical consultation, and I’m delighted that he has agreed to send in a report from the front line.

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Lucas Seuren, Oxford University

The outbreak of the COVID-19 pandemic has radically changed the organisation of healthcare services. Social distancing protocols mean that face-to-face contact between patients and health care professionals has to be limited as much as possible. Consultations are now mostly conducted by telephone or video. This provides a unique opportunity for EMCA research on healthcare interaction, but also a significant challenge. Little is still known about how communication works in these remote service models, and as experts on social interaction, we are in a prime position to develop evidence-based guidance. The problem is: how do we get data when we cannot go to places where the interaction take place?

Our research group in Oxford (Interdisciplinary Research in Health Sciences) has been studying video consultations for nearly a decade, and we recently secured funding from the UKRI to investigate the new Remote-by-Default service models in primary care. This project involves a small work package in which we will be investigating how health care professionals assess potential COVID-19 patients during video consultations, with a particular focus on how they assess breathlessness and fatigue. So how did we address the challenges involved in doing this research?

Protocol

The first challenge in studying video consultations is figuring out how to record the data. This used to be relatively straightforward in the pre-COVID era. In previous research projects, we set up multiple cameras, both in the clinic and the patient’s homes [1, 2]. These would capture the participants as well as their screen and audio feeds (see for example figure 1). In this way, we could get a decent picture of what each participant was doing as well as what they could see and hear of their co-participant. In practice it was not always feasible to get all cameras set up and record in both locations, but we coped.

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Figure 1: Four angles during heart failure video consultation

For our new research project, we had to develop a protocol that would give us decent quality data that was also ethically sound. We essentially had to deal with two problems. First, we did not actually have access to the consultations, and second, since we are dealing with acute and potentially serious COVID-19 cases, we could not secure informed consent from patients before the consultation.

Compromise! 

To even get data, we had to compromise on the quality. Many videoconferencing solutions like Zoom have built-in recording options, which would mean clinicians could simply record the consultation with the push of a button. Health care providers, however, frequently use specialised video consultation software, such as Attend Anywhere, in which recording is not possible. For these cases, we decided to opt for commercial screen and audio capture programmes that do the same job. In cases where this option is not available, we decided to opt for commercial screen and audio capture programmes that do the same job.

While fairly straightforward, the downside is that you get a very limited picture of the interaction. You only record what the clinician sees and hears on their computer, which is hardly the complete participants’ perspective. It provides few insights into how participants use the technology, the environment in which the interaction takes place, how lag and other technological disruptions shape participant behaviour, or how they use their bodies off-screen. We settled for this limited view, because given our research goals and the practicalities around social distancing, we think we can develop an adequate analysis with one-sided recordings.

Ethics

The bigger problem was setting up a recording protocol that would meet ethical standards. Our first proposal was for the clinicians to initiate the recording at the start of the consultation, in order not to delay the clinical assessment, and to inform the patients and secure verbal consent at the end of the consultation.

Informed consent is, however, not taken lightly, and so we had to make some adjustments. While we can still get verbal consent after the consultation has taken place, clinicians have to ask patients at the start of the consultation if they can record it. They then have to store the recordings until the point we have been able to talk to the patient, explain the study, and record consent. After that, we use secure data transfer services to move the recordings from the clinician to the secure servers in Oxford. It’s a bit of a hassle, but workable enough.

Fortunately for us, because our research was urgent, both our local Research Governance department and the Research Ethics Committee prioritised the study. Normally this process would likely have taken many months, but in this case we actually had REC approval in the first week of the study! That means that in little over a month we went through the entire research ethics procedure. Well, almost the entire procedure, since we will still need to secure local approval from each clinical site. But clinicians have been very keen to work with us, and so moving forward has not been much of a problem.

Evidence-based Guidance

The goal of this project is of course not simply to investigate how clinicians assess breathlessness and other COVID symptoms by video. We aim to develop evidence-based guidance on how to do this effectively and efficiently. There are currently no established and empirically validated tools [3]. CA can make a vital contribution to addressing the pandemic, because we can show in details which practices clinicians use (not only which ones they report using), how these are understood or misunderstood by patients, and what that means the clinical assessment.

The only real issue now is that lockdown measures have largely been so effective, few patients still call their GP because they might have COVID. We are told a second wave is likely inevitable in the autumn when life moves back indoors. On the one hand, I’d be very happy if that turns out not to be the case. But looking at how the virus is re-emerging in parts of Australia, France, Germany, and with a growing infection rate in the UK, it seems likely that the peak of our work is still to come.

References:

  1. Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, Hanson P, et al. Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study. Health Services and Delivery Research. 2018;6(21):1-136. doi: 10.3310/hsdr06210.
  2. Shaw SE, Seuren LM, Wherton J, Cameron D, A’Court C, Vijayaraghavan S, et al. Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: A Linguistic Ethnographic Study of Video-Mediated Interaction. J Med Internet Res. 2020;22(5):e18378. doi: 10.2196/18378.
  3. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. Bmj. 2020. doi: 10.1136/bmj.m1182.

 

Guest Blog: A research visit to Helsinki during the pandemic

Sometimes a much-anticipated research visit to a centre of excellence coincides with an unforeseen set of circumstances. That’s what happened to Rachael Drewery, who turned up in Helsinki only to be caught up in the Finnish lockdown. She tells her tale…

Rachael Drewery

Rachael Drewery, Nottingham University

On 18th February, when reports about COVID were found in the middle of UK newspapers, I commenced a three month research visit with the Emotions in Interaction team at the University of Helsinki.  Little did I know that four weeks later I would be conducting a research visit, via online platforms, during a global pandemic.

There I was in Helsinki, seeing COVID rates going up and the numbers using public transport suddenly going down. But after talking it over with my Nottingham supervisors, and with my Helsinki host Anssi Peräkylä, I decided to stay on in this beautiful city and continue my research visit.  Like everyone else, I had to adapt rapidly – setting up a home office, learning how to use online platforms and reassessing the aims for my research visit.  No longer would I be visiting other universities and healthcare institutions, but I could engage in online data sessions and reading groups, and the opportunity to enrol in Helsinki University’s course ‘Goffman and social encounters’ presented itself.

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Helsinki University, Senate Square, pre-lockdown

The timing of that course on Goffman was especially lucky for me.  Selecting and analysing online videos created opportunities for light relief e.g. the widely viewed You Tube video ‘children interrupting a news interview’.  Daily news briefings and outings became resources for considering Goffman’s theories in a pandemic e.g. how health care leaders maintain ‘face’ while admitting that they broke social distancing rules.

Data sessions online

Helsinki has a rich tradition of work utilising conversation analysis and both the Emotions in Interaction and the Intersubjectivity in Interaction groups quickly moved data sessions online.   While online sessions involved new challenges for everyone, including concurrently managing transcripts and video, and turn-taking during discussions, sessions were attended by a large number of participants from different disciplinary backgrounds (perhaps more than if the data session had been in a building).  For a visiting researcher, the opportunity to present data on nurse-patient interaction and to participate in a wide variety of data sessions, including empathy in a book club (Liisa Voutilainen), physiotherapy in mental health settings (Katja Mustonen) and dog walking (Mika Simenon), provided opportunities to develop my analytic skills and gain knowledge from colleagues working in different disciplines.

In addition to data sessions, the Emotions in Interaction team offered a regular reading group and a weekly online coffee break.   Weekly coffee breaks were supportive, breaking the isolation of working and living in one room.  They were also an opportunity to discuss how work including the project Facing Narcissism was progressing during COVID and, being a group of sociologists studying interaction, lots of discussion about observations from people’s daily lives – especially whether people ‘swerve’ to maintain social distancing.   In Helsinki wide pavements, quiet streets and a recommendation to maintain one metre distance from others appeared to allow social distancing without having to actively swerve.

The pandemic in the public sphere

While conducting a research visit during a pandemic was at times difficult, focusing on social interaction presented lots of opportunities to think and apply my learning to what was happening around me.  Observing how people interacted in public spaces as COVID rates increased, how people maintained one metre distance when out cycling or walking, and how people navigated the new rules about travel on public transport during my return to the UK all provided opportunities to think about interaction in an era of social distancing.

Empty departure halls, Helsinki airport, 16th May 2020

Empty departure hall, Helsinki Airport, May 16th 2020

Thank you to my supervisors and everyone at the University of Helsinki who facilitated my staying in Helsinki during a pandemic.  Special thanks to Anssi Peräkylä who took the time to supervise me, and to and the Emotions in Interaction Team (Mariel Wuolio, Aurora Guxholli, Maarit Lehtinen, Katja Mustonen, Liisa Voutilainen, Emmi Koskinen, Pentti Henttonen,) who welcomed me into their team.

 

Guest blog: A philosopher looks at Conversation Analysis

Coming across an interview with Susan Notess on the excellent Generous Questions philosophy podcast, I was intrigued by her perspective, as an ethicist, on the dangers of language – and delighted that she used the work of conversation analysts Liz Stokoe and Nick Enfield, among others, to illustrate her argument. She very kindly agreed to write a guest blog,  introducing us to a wider horizon of scholarship about the human conversational contract.

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Susan Notess, Durham University

There’s something about language which resembles conductivity. Through it we connect with each other and transmit not just stories, but also fears; not just kindness, but also power. To be able to speak and say what one means is a kind of power, and to be robbed of this power is a kind of injustice. Continue reading

Guest blog: Walking in the time of COVID-19

Lockdown has been socially, professionally and personally challenging for lots if us; but it has also stimulated a great deal of new work in response to the very different landscape we currently live in. I’m delighted to host a guest blog by four wonderful analysts, Eric Laurier, Magnus Hamann, Saul Albert & Liz Stokoe, who’ve used some of their time for a fascinating analysis of just what  “social distancing” means in public spaces. It’s a longer than usual blog, but there’s a lot to pack in… Continue reading

Guest Blog: How does a market trader get customers?

In a recent paper in ROLSI, Kenan Hochuli reported a remarkable study of the complex world of the street market. I’m delighted that he’s prepared a guest blog on the subject, concentrating on the crucial step in the selling process: getting the passer-by to stop.

Kenan Hochuli

Kenan Hochuli, Neuchâtel and Zurich

Market stalls are unique service institutions. They are located in public spaces and approachable from different directions. There are no material or technical devices that determine the sequence of sales. Sometimes it is not clear whether a person is just passing by a stall or if they intend to buy something. And this often happens in the course of already ongoing sales interactions. In view of these conditions, my article deals with seller’s efforts in transforming passers-by into customers and, more generally, participants negotiation of co-presence in the course of emerging multi-party-encounters. Continue reading

Guest blog: Supporting communication in dementia research

A growing area of application of Conversation Analysis is in helping people deal with the difficulties of dementia. In this very welcome guest blog, Joe Webb and Jemima Dooley tell us how adapting qualitative approaches could help people communicate their stories, and describe an exciting new collaboration with people who actually live with the condition.

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Joe Webb, Bristol

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Jemima Dooley, Bristol

A growing body of conversation analysis (CA) research focuses on dementia and communication (see Dooley et al., 2015, and Kindell et al., 2017 for overviews). However, people living with dementia are also keen to tell their own stories and be active researchers (McKeown et al., 2010). Continue reading

Guest blog: the EM/CA Bootcamp, 2018

Each year colleagues in Denmark organise an intensive get-together for postgraduates and other early-career researchers who want to delve into the mysteries of ethnomethodology and Conversation Analysis. I’m glad to say that Sophia Fiedler & Søren Sandager Sørensen have sent in this insider’s report….

Søren Sandager Sørensen, Aarhus
Sophia Fiedler, Neuchâtel 

When you travel to Denmark, your luggage so full of text by Garfinkel, Schegloff and Jefferson that you’ve struggled to get your clothes into your suitcase; when the only geographical clue you have about your exact location in Denmark is the fact that you are not far from the sea; when – additionally – there are only linguists (and a few sociologists) in the house where you will stay for 5 days… Continue reading

Guest Blog: Marina Cantarutti on presenting CA to the public

Explaining what we do to the general public can be a daunting exercise, but the rewards can be well worth it.  Marina Cantarutti, doing her doctoral research at the University of York, took on the task, and presented her work at a science fair of the kind that hosted Saul Albert and colleagues’ excellent CA Rollercoaster. She lived to tell the (happy) tale…

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Marina Cantarutti, University of York

For some areas of linguistics, it may be a bit difficult to make your work accessible to the public without feeling you are betraying yourself, or your knowledge. The fear of trivialising is always at the back of one’s mind. Moreover, when you’re out there on your own, you are the sole representative of the discipline … daunting! Continue reading

Guest blog: doing a data-session ‘remotely’

Some researchers are lucky enough to work in a community of like-minded scholars, with whom they can easily chat, meet up and collaborate; when that’s not the case, the isolation can be damaging. That’s why it’s so heartening to see a group of UK postgraduates inaugurate a regular “remote” data session, bringing people together who would otherwise be apart. This lively blog by Marina Cantarutti, Jack Joyce and Tilly Flint gives the story.

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Marina Cantarutti

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Jack Joyce

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Tilly Flint

Continue reading