Ethical and Quality of Care–Related Challenges of Digital Health Twins in Care Settings for Older Adults: Scoping Review
Background: Digital Health Twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. Despite its many benefits, the optimum implementation of DHTs has faced several challenges, particularly ethical and quality-of-care-related issues. Given the continuous rise in the need for such care and the evident potential for DHTs to meet these needs, this review seeks to identify and address the gaps in research knowledge to enhance DHT implementation. Objective: The review aims to compile and synthesise the best available evidence regarding the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings. Methods: The review followed the Joanna Briggs Institute (JBI) methodology as a guide. The published studies were searched through Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, JBI, and Web of Science, and the unpublished studies were searched through Mednar, Trove, OCLC WorldCat, Dissertations and Theses. Studies published in English from 2016 were considered. This review included studies of older individuals (60 years or above) undergoing care delivery associated with DHTs and respective care providers. The concept included the application of the technology, and the context involved studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text, and opinion studies, was considered. Two independent reviewers screened the titles and abstracts and reviewed the full text. Results: The results will be presented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram. Two draft charting tables were developed and presented. A summary of the characteristics of the included studies was then described in terms of location, study sites, timing, participants, and outcomes measured/phenomena of interest. A result-based convergent (integrated) synthesis design was used to identify five key challenges. Those challenges included 1) data security and privacy concerns,2) equity and accessibility of healthcare, 3) effectiveness concerning context, timing, and location, 4) ethical implications regarding autonomy, consent, and overdiagnosis, and 5) the impact of DHTs on healthcare workflows and provider workload. Conclusions: The studies reviewed reveal several critical characteristics regarding DHT technologies' implementation and ethical considerations, particularly addressing safety, equity, timing, location, participant characteristics, and their impact on workflow. The implications of these challenges emphasise the necessity for more practical ethical guidelines and policy frameworks to mitigate the potential risks associated with DHT application in older care. Further research should be conducted to examine other dimensions of the quality of care, such as access, timeliness, acceptability, and appropriateness.
