Cognitive/behavioral approaches: Providing web-based treatment follow-up services for chronic pain management programs: Ethical concerns, professional issues and design considerations

Abstract

Multidisciplinary chronic pain treatment programs teach patients to incorporate symptom-management strategies into their daily routine, including exercise, activity pacing, proper body mechanics, relaxation and cognitive-behavioural strategies for stress and emotional distress. Such programs have been shown to result in decreased pain, disability levels and health care utilization, and improved psychosocial functioning. However, many patients are unable to maintain these significant lifestyle changes long-term. Patients attending our multidisciplinary Rheumatology Day Programs have identified a need for treatment follow-up to facilitate long-term maintenance, but these services are limited due to current staffing constraints. The Arthritis Institute Internet Clinic (AIIC) was proposed as a means to offer novel, cost-effective follow-up treatment through both education and interactive, on-line problem-solving / relapse prevention workshops. This presentation will provide an in-depth examination of the ethical and professional issues involved in providing web-based treatment services. Existing guidelines for web-based health care and research will be reviewed, addressing issues such as the informed consent process, participant privacy and confidentiality, clinician – client communication, and professional accountability. Challenges faced during the program development phase of the AIIC will highlight the fact that development of comprehensive ethical and professional guidelines for web-based treatment and research has not kept pace with rapid advances in the field of e-health. Specific guidelines and practical solutions will be provided for a number of ethical concerns and professional dilemmas faced in the development of the Arthritis Institute Internet Clinic. Future research will examine patients' willingness to use web-based follow-up treatment services, and will determine if web-based treatment follow-up services will result in improved disease management and decreased health care utilization.