title: Exploring eHealth Ethics and Multi-Morbidity: Protocol for an Interview and Focus Group Study of Patient and Health Care Provider Views and Experiences of Using Digital Media for Health Purposes.
abstract: BACKGROUND
  eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to medical consultations (telemedicine) and multiple forms of health education, support, and tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has the potential to accelerate the shift from traditional "passive patient" to an informed, engaged, and empowered "patient as partner," equipped to take part in shared decision-making, and take personal responsibility for self-managing their illness.
  
  
  OBJECTIVE
  The objective of our study is to examine how people with chronic illness use eHealth in their daily lives, how it affects patient-provider relationships, and the ethical and practical ramifications for patients, providers, and service delivery.
  
  
  METHODS
  This two-phase qualitative study is ongoing. We will purposively sample 60-70 participants in British Columbia, Canada. To be eligible, patient participants have to have arthritis and at least one other chronic health condition; health care providers (HCPs) need a caseload of patients with multi-morbidity (>25%). To date we have recruited 36 participants (18 patients, 18 HCPs). The participants attended 7 focus groups (FGs), 4 with patients and 3 with rehabilitation professionals and physicians. We interviewed 4 HCPs who were unable to attend a FG. In phase 2, we will build on FG findings and conduct 20-24 interviews with equal numbers of patients and HCPs (rehabilitation professionals and physicians). As in the FGs conducted in phase I, the interviews will use a semistructured, but flexible, discussion guide. All discussions are being audiotaped and transcribed verbatim. Constant comparisons and a narrative approach guides the analyses. A relational ethics conceptual lens is being applied to the data to identify emergent ethical issues.
  
  
  RESULTS
  This study explores ethical issues in eHealth. Our goal is to identify the role of eHealth in the lives of people with multiple chronic health conditions and to explore how eHealth impacts the patient role, self-managing, and the patient-HCP relationship. The ethical lens facilitates a systematic critical analysis of emergent ethical issues for further investigation and pinpoints areas of practice that require interventions as eHealth develops and use increases both within and outside of the clinical setting.
  
  
  CONCLUSIONS
  The potential benefits and burdens of eHealth need to be identified before an ethical framework can be devised.
authors.affiliation: Milan Ilich Arthritis Research Center of Canada, Richmond, BC, Canada. atownsen@exchange.ubc.ca.
authors.forename: Anne
authors.identifier: 0000-0002-8271-110X
authors.initials: A
authors.lastname: Townsend
authors.forename: Paul
authors.initials: P
authors.lastname: Adam
authors.forename: Linda C
authors.initials: LC
authors.lastname: Li
authors.forename: Michael
authors.initials: M
authors.lastname: McDonald
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Backman
keywords: Internet health; arthritis; decision-aids; eHealth; ethics; health tools; multi-morbidity; patient role; patient/doctor engagement; self-management