Incidental findings in development and use of digital health ecosystems for older people

Abstract

Healthcare sectors are globally facing challenges delivering services for older people,. Although the implementation of digital technology has brought positive effects on caring older people in their homes, it has also resulted in arising ethical challenges including incidental findings (IF). The purpose of this systematic review is to reveal ethical challenges in the development and use of digital health ecosystems for older people. The objectives are 1) to reveal incidental findings, 2) ethical vulnerabilities and treats for integrity associated with the use of Artificial Intelligence (AI); 3) to analyse ethical management of IF, and 4) to create recommendations for the use and development of digital health ecosystems. Systematic data search was completed in ProQuest, EBSCOhost, and Ovid databases. Peer-reviewed full text research articles on ethical guidelines for developing and implementing digital health ecosystems for care of older people published in English between 2012 and 2022 were included. Previously published articles focusing on younger population or other than digital services were excluded. The included thirteen articles were appraised by design specific tools (PRISMA 2009, SANRA, STROBE, CAGSCS). The article texts were analysed and reported thematically. The IF revealed were violation of user autonomy, independence, and privacy during the development and use of the ecosystems; social isolation of the end-user; user unfriendly devices; additional workload to the care providers; technology induced anxiety; and biases and errors in use of the ecosystems. The ethical vulnerabilities and threats to integrity associated with use of AI. Observation and implementation of ethical values were found important in co-creation of ethically conscious ecosystems for older people. Empowering the designers, developers, and healthcare professionals on ethical competencies, and inclusion of the end-users’ preferences in designing of digital health ecosystems were included in the constructed recommendations. This article disseminated within the SHAPES Horizon 2020 project.