Exploring patient involvement and influencing factors in digital interdisciplinary consultation

Objectives: We explored patient attitudes and experiences around their involvement throughout the digital interdisciplinary consultation (DICO) process and identified its influencing factors. DICO is defined as asynchronous, targeted communication between GPs and hospital specialists via a secure electronic application where patient-specific information is shared, and clarification or guidance is sought concerning a clinical question. Methods: We conducted a qualitative study in the Netherlands. A conceptual framework was iteratively developed to identify phases of DICO where patient involvement is possible, drawing on literature research and expert meetings. Data from three interrelated studies performing semi-structured interviews regarding patients' experiences with various types of DICO were triangulated. The conceptual framework was expanded with factors influencing the degree of patient involvement at each phase, based on the findings from the patient interviews. Results: We analyzed 27 patient interviews. Patients viewed DICO as an initial step in care, with limited active involvement required. From the perspective of the patient, the decision to initiate DICO is typically made by the GP, often without patient input. GPs initiate DICO for various reasons and patient involvement varies depending on the reason. Key factors influencing involvement as perceived by patients include the GP-patient relationship, particularly trust, the nature of the medical problem (e.g., urgency and severity), and patients’ needs and preferences. Patients appreciated post-DICO discussions, particularly in cases of uncertainty, and considered shared decision making important when DICO leads to health decisions. Conclusions: The study highlights how the level of patient involvement in DICO varies depending on the reason for initiating DICO, the nature of the medical problem, patients’ needs and preferences, and the GP-patient relationship. Practice implications: Findings from this study show patient involvement in DICO is context-dependent; GPs should tailor involvement across multiple DICO phases, especially when providing feedback on the outcome of DICO. Findings can contribute to future guidelines for effective, patient-centered DICO implementation.