Comparisons of Communication in Medical Face-To-Face and Teleconsultations: A Systematic Review and Narrative Synthesis

Figures & data

Table 1. Databases, search fields, search exclusions, MeSh/equivalent terms, and search terms used when searching literature.

Database	Fields searched	Excluded from results	MeSH/equivalent terms	Search terms
Linguistics Abstracts Online	EBSCO default (abstract, title, keywords)	Magazines (1)	Made no difference	(communic* OR interact* OR conversat* OR talk* OR empath* OR rapport OR discourse OR discursive OR relation*) AND (telemedic* OR telehealth* OR teleconsult* OR “telephone consult*” or “phone consult*” OR “remote consult*” OR “virtual consult*” OR “video consult*”)
CINAHL	EBSCO default (abstract, title, keywords)	None	Found five additional records
Psycinfo	OVID’s ‘.mp’ field code (abstract, title, keywords, heading word, table of contents, key concepts, original title, tests and measures, and MeSH terms)	None	Made no difference
Scopus	Scopus’s TITLE-ABS-KEY search	Reviews (2445), Notes (472), Editorials (427), Letters (379), Short Surveys (194), Conference Reviews (141), Errata (5), Data Papers (1), Retracted papers (1)	N/A
MEDLINE	EBSCO default search (abstract, title, and keywords)	Magazines (75) and Guidelines 920)	N/A
Applied Social Sciences Index and Abstracts	ProQuest’s ‘noft’ field code (everything but full text)	None	N/A	(communic* OR interact* OR conversat* OR talk* OR empath* OR rapport OR discourse OR discursive OR relation*) AND (telemedic* OR telehealth* OR teleconsult* OR “telephone consult*” or “phone consult*” OR “remote consult*” OR “virtual consult*” OR “video consult*” OR “teleconsultation” OR “telephone consultation*” OR “phone consultation*” OR “remote consultation*” OR “virtual consultation*” OR “video consultation*”)
Sociological Abstracts	ProQuest’s ‘noft’ field (everything but full text)	None	N/A
Social Science Database	ProQuest’s ‘noft’ field (everything but full text)	None	N/A

Figure 1. A flow diagram showing the paper screening process (from Page et al., 2021; visit: http://www.prisma-statement.org).

Table 2. Papers reviewed.

Paper	Setting	Country	Type(s) of telemedicine	No. of participants	Data	Approach
Quantitative studies
Agha, Roter et al. (2009)	Pulmonary consultations in veterans’ hospitals	USA	Video	19 patients (11 video, 8 face-to-face)	Video recordings of consultations	Coding: Roter Interaction Analysis System (RIAS) Other: Measured duration and verbal dominance
Agha et al. (2010) [Conference abstract]	Veterans’ hospital pulmonary, endocrine, and rheumatology clinics	USA	Unsure	221 patients (111 video, 110 face-to-face)	Video recordings of consultations	Coding: Roter Interaction Analysis System (RIAS) Other: Measured duration and verbal dominance
Ball et al. (1995)	Acute psychiatric unit	UK	Telephone, hands-free telephone, and video	6 patients (all patients took part in all conditions)	Video and audio recordings of consultations	Coding: Stiles Verbal Response Modes (VRM) for verbal behavior Video Interactive Techniques for Automated Scoring System (VITAS) for non-verbal behavior
Day and Schneider (2002)	Psychotherapy	USA	Audio and video	80 clients (27 face-to-face, 26 video, 27 telephone) Each client received five sessions each	Video recordings	Coding: Vanderbilt Psychotherapy Process Scale
Demiris et al. (2005)	Dermatology	USA	Video	94 patients (40 face-to-face, 54 telemedicine)	Audio recordings	Coding: Protocol inspired by the Davis Observation Code Other: Measured duration and verbal dominance
Edison et al. (2013)	Dermatology	USA	Video	91 patients (41 face-to-face, 50 telemedicine)	Audio recordings	Coding: Protocol inspired by the Davis Observation Code Other: Measured duration and amount of talk from each party
Frueh et al. (2007)	Group therapy	USA	Video	38 clients (21 face-to-face, 17 video) Clients participated in 17 sessions total	Audio recordings	Coding: Social and emotional rehabilitation-therapist adherence and competency protocol (SER-TACP)
Hammersley et al. (2019)	Primary care follow-up consultations	UK	Video and telephone	149 patients (51 face-to-face, 53 telephone, 45 video)	Audio recordings	Coding: Royal College of General Practitioners (RCGP) quality indicators RIAS Other: Measured duration
Innes et al. (2006)	Primary care	UK (this study), USA (existing comparison study)	Telephone	43 telephone patients Comparisons were made with findings from earlier study of face-to-face consultations involving 277 patients	Audio recordings	Coding: RIAS
Laflamme et al. (2005)	Nursing home	USA	Video	41 nursing home residents (12 face-to-face, 29 video)	Video recordings	Coding: Bespoke 31-item instrument Measured duration
Liu et al. (2007)	Primary care (internal medicine)	Japan	Video	20 patients All patients took part in both conditions, with 10 having face-to-face first and 10 having video first (total of 40 consultations)	Video recordings	Coding: Bespoke system based on Brink-Muinen et al.’s (2002) work on verbal behavior (included duration)
McKinstry et al. (2010)	Primary care	UK	Telephone	105 patients (59 face-to-face, 46 telephone)	Audio recordings	Coding: RIAS RCGP criteria Observing Patient Involvement in Decision Making (OPTION) measure Other: Measured duration and number of problems
McKinstry et al. (2011)	Primary care	UK	Telephone	144 (94 face-to-face, 50 telephone)	Audio recordings	Coding: Bespoke system (coding for consultation characteristics postulated to influence patient recall) Other: Measured duration and whether more than one problem was discussed
Stredler-Brown (2017)	Early intervention for children who are deaf or hard of hearing	USA	Video	16 clients and their parents Comparisons were made with existing findings from the literature	Video recordings	Coding The presence of four behaviors (observation, direct instruction, parent practice with feedback, child behavior with provider feedback) used to coach parents of children who are deaf or hard of hearing
Tachakra and Rajani (2002)	Minor accident and treatment service	UK	Video	60 patients (30 face-to-face, 30 video)	Video recordings	Coding: Consultation statistics (mean number of turns, words, interruptions, backchannels, and repairs)
Qualitative studies
Ekberg et al. (2019)	Speech and language therapy	Australia	Video	4 clients (2 face-to-face, 2 video) 11 participants total, but analysis focuses on 4	Video recordings	Conversation analysis, with a focus on the different ways that speech and language therapists use physical objects depending on communication modality
Hewitt et al. (2010)	Primary care	UK	Telephone	65 patients (33 face-to-face, 32 telephone)	Audio recordings	Conversation analysis, with a focus on, amongst other things, how multi-problem consultations are handled in the different communication modalities
Pappas and Seale (2009)	Televascular and telecardiology	UK	Video	10 patients (5 telecardiology, 5 televascular)Comparisons were made with data extracts from Heath (1981, 1986)	Video recordings	Conversation analysis, with a focus on the opening phase of the consultation
Shaw et al. (2020)	Diabetes, antenatal diabetes, cancer surgery, heart failure	UK	Video	Diabetes: 18 patients (7 face-to-face, 12 teleconsultations) Antenatal diabetes: 12 patients (6 face-to-face, 6 teleconsultations) Cancer: 18 patients (6 face-to-face, 12 teleconsultations) Heart failure: 16 patients (9 face-to-face, 7 teleconsultations)	Video recordings (teleconsultations), audio recordings (face-to-face consultations)	Linguistic ethnography and conversation analysis, with a focus on openings and closings, physical examinations, problems with technology, and turn-taking
Stommel et al. (2019)	Post-operative consultations	Netherlands	Video	39 patients (17 face-to-face, 22 video)	Video recordings	Conversation analysis, with a focus on how surgeons display other-attentiveness at the beginning of consultations
Stommel et al. (2020)	Post-operative consultations	Netherlands	Video	39 patients (17 face-to-face, 22 video)	Video recordings	Conversation analysis, with a focus on the different ways that wound assessments are carried out between the two modalities
Mixed methods
Shaw et al. (2018)	Diabetes, antenatal diabetes and cancer surgery	UK	Video and audio	Adult/young adult diabetes: 12 patients (6 face-to-face, 6 teleconsultations) Antenatal diabetes: 12 patients (6 face-to-face, 6 teleconsultations) Cancer surgery: 10 patients (5 face-to-face, 5 teleconsultations)	Video recordings (teleconsultations), audio recordings (face-to-face consultations)	Quantitative coding: RIAS Quantitative other: Measured duration and verbal dominance Qualitative: Although the primary focus is on the coding, the authors do include transcript extracts and qualitative observations

Note that if comparisons were done as part of a wider study or project (e.g. if interviews or questionnaires were collected alongside the recorded communication data), only data relevant to the comparisons is included in this table.

Table

Paper	Comparisons favoring FtF	Comparisons favoring TM	No significant difference	Total no. of comparisons
Primary care
Liu et al. (2007) [Japanese internal medicine]	9 Duration and dominance^1: 5 Other: 4 Longer (according to several measures of duration, including time, utterances, and conversational turns), with more empathy, praise, and facilitation.	0	5 Duration and dominance: 2 Other: 3 No differences in certain measures of duration (e.g. utterances per minute), simultaneous utterances, and questioning (open and closed).	14 Duration and dominance: 7 Other: 7
McKinstry et al. (2010) [British general practice] [Based on adjusted p values]	9 Duration and dominance: 2 Other: 7 Longer, with more problems discussed, information exchange, patient education/counseling, direction giving, and rapport building.	0	21 Duration and dominance: 1 Other: 20 No differences in verbal dominance, patient-centeredness/involvement, and partnership building/disagreement. All but one RCGP quality criteria non-significant.	30 Duration and dominance: 3 Other 27
McKinstry et al. (2011) [British general practice]	3 Duration and dominance: 2 Other: 1 Longer, with more multi-problem consultations and repetition of instructions/advice (for advice aspect of consultation only).	0	16 Duration and dominance: 0 Other: 16 No differences in checking patient understanding, use of technical language, use of written materials, and various aspects of advice-giving (e.g. asking patient to repeat). Note that some variables did not appear at all in either modality.	19 Duration and dominance: 2 Other: 17
Hammersley et al. (2019) [British general practice]	13 Duration and dominance: 1 Other: 12 More problems discussed in face-to-face as compared to video (though not telephone) consultations. More patient education and counseling for both doctors and patients compared to both video and telephone, and more data gathering (except when compared to patients on the telephone). More direction-giving and partnership building compared to doctors in video consultations only.	3 Duration: 0 Other: 3 More rapport building (telephone for doctors and patients, video for patients only).	26 Duration and dominance: 1 Other: 25 No difference in number of problems when compared to telephone consultations. No differences in most RCGP indicators for either doctors or patients. On the RIAS, there were no differences in for doctors or patients in video or telephone for disagreement. All other RIAS variables showed at least one difference, although not always across every single comparison (see second column). Note that, for some comparisons, the variable did not appear at all in either modality.	42 Duration and dominance: 2 Other: 40
Secondary care
Frueh et al. (2007) [Therapy sessions]	0	1 Competence rated higher when introducing “homework” assignments.	18 No differences in all other aspects of adherence to/competence with protocol, including therapist’s explanations, empathy and rapport, and providing feedback.	19
Ball et al. (1995) [Psychiatry]	0	0	6 No differences in non-verbal (angle of recline and mutual gaze) and verbal (interpretations, reflections, advisements, questions) behaviors.	6
Day and Schneider (2002) [Psychotherapy]	0	2 More client participation in both video and audio-only conditions.	4 No differences for client hostility or therapist explanation between face-to-face and video/audio-only.	6
Demiris et al. (2005) [Dermatology	1 Duration and dominance: 1 Other: 0 Longer.	1 Duration and dominance: 0 Other: 1 More small talk.	6 Duration and dominance: 0 Other: 6 No differences in assessment, psychosocial talk, education, treatment discussion, compliance promotion, and administrative talk.	8 Duration and dominance: 1 Other: 7
Edison et al. (2013) [Dermatology]	1 Duration and dominance: 1 Other: 0 More non-physician words (i.e. patients and companions spoke more). NOTE: A sub-variable of “Promoting compliance,” “Positive reinforcement,” was also significantly higher in face-to-face consultations.	0	15 Duration and dominance: 1 Other: 14 No significant difference in duration. Other main communication variables the same as Demiris et al., above. Edison et al. compared these variables twice (based on both number of words devoted to them and whether the variable was present), with no significant differences in either case.	16 Duration and dominance: 2 Other: 14
Agha, Roter, et al. (2009) [Pulmonology]	3 Duration and dominance: 0 Other: 3 Fewer requests for repetition and unintelligible utterances. Patients (but not doctors) give more orientation.	0	26 Duration and dominance: 3 Other: 23 No difference in duration, companion contribution, and dominance ratio. No differences in affect ratings, and no differences in all other RIAS variables (information exchange, types of talk, and rapport and partnership).	29 Duration and dominance: 3 Other: 26
	39 Duration and dominance: 12 Other: 27	7 Duration and dominance: 0 Other: 7	143 Duration: 8 Other: 135	189 Duration: 20 Other: 169

¹Refers to both variables that measured the length of the consultation, variables that measured professionals’ dominance, and the closely related variables that were discussed alongside these in the main text (e.g. number of problems discussed).

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