The Work of Re-Contextualising Patient Information: Clinical Decision-Making in the Era of Patient Reported Outcomes

• In Event: Health, Interrupted: Infrastructures and Tinkering in Telecare

Abstract

With the intention and hope of reducing unnecessary clinical visits and obtaining patient-involving care home-based Patient Reported Outcome (PRO) questionnaires are being applied as screening tools. It is argued that with PRO tools – electronic questionnaires and algorithmic sorting of answers - clinical practice can obtain rich and more systematic insight into patient needs. However, reaching the health care professional (HCP), patient insights have been encoded as quantified data, already digested by an algorithm. In this paper, we explore how PRO-data is enacted by HCPs in cancer follow-up care. We show, that PRO-data constitute decontextualized patient information – digestible by an algorithm, however, entailing a subsequent ascription of contextual data. No decisions are made solely on the basis of PRO-data. We argue, that the work of re-contextualising PRO-data constitute an act of care as it qualifies the information and enables decision-making. Re-contextualising involves searching through medical reports, looking into prior and future medical appointments, and talking to colleagues. We find, that PRO-data allow for targeted re-contextualization work, as it guides HCPs towards supplementing information of specific relevance. However, HPCs also compile non PRO-specific information as they try to put a name to the PRO-response, either literally by trying to remember the patient or by gathering sufficiently details to form a clear picture. Highlighting the divergence between the algorithmic suitable PRO-data and attending re-contextualising this paper contribute with a nuanced understanding of what it takes to know patients in today’s datafied healthcare practices.

Authors

• Rikke Torenholt, Copenhagen University

• Henriette Langstrup, University of Copenhagen