Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Oct 1:10:20552076241277705.
doi: 10.1177/20552076241277705. eCollection 2024 Jan-Dec.

Socio-ethical challenges and opportunities for advancing diversity, equity, and inclusion in digital medicine

Ivana Paccoud  1   2 , Anja K Leist  3 , Isabel Schwaninger  1   2 , Robin van Kessel  4   5   6   7 , Jochen Klucken  1   2   8
Affiliations
Review

Socio-ethical challenges and opportunities for advancing diversity, equity, and inclusion in digital medicine

Ivana Paccoud et al. Digit Health. .

Abstract

Digitalization in medicine offers a significant opportunity to transform healthcare systems by providing novel digital tools and services to guide personalized prevention, prediction, diagnosis, treatment and disease management. This transformation raises a number of novel socio-ethical considerations for individuals and society as a whole, which need to be appropriately addressed to ensure that digital medical devices (DMDs) are widely adopted and benefit all patients as well as healthcare service providers. In this narrative review, based on a broad literature search in PubMed, Web of Science, Google Scholar, we outline five core socio-ethical considerations in digital medicine that intersect with the notions of equity and digital inclusion: (i) access, use and engagement with DMDs, (ii) inclusiveness in DMD clinical trials, (iii) algorithm fairness, (iv) surveillance and datafication, and (v) data privacy and trust. By integrating literature from multidisciplinary fields, including social, medical, and computer sciences, we shed light on challenges and opportunities related to the development and adoption of DMDs. We begin with an overview of the different types of DMDs, followed by in-depth discussions of five socio-ethical implications associated with their deployment. Concluding our review, we provide evidence-based multilevel recommendations aimed at fostering a more inclusive digital landscape to ensure that the development and integration of DMDs in healthcare mitigate rather than cause, maintain or exacerbate health inequities.

Keywords: AI fairness; Socio-ethical considerations; datafication, privacy and trust‌; digital determinants of health; digital health equity; diversity, equity and digital inclusion.

PubMed Disclaimer

Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.K. declares an unpaid role in the European Taskforce for Harmonized Evaluation of Digital Medical Devices. A.L. has served on advisory boards with Roche (remunerated). None of the other authors report conflicts of interest.

Figures

Figure 1.
Figure 1.
A hypothetical DAG that highlights the interconnectedness of factors influencing participation and attrition rates of socially disadvantaged communities in clinical trials of DMDs.
Figure 2.
Figure 2.
Multilevel recommendations for the advancement of equity across different socio-ethical challenges in digital medicine.
See this image and copyright information in PMC

References

    1. van Kessel R, Roman-Urrestarazu A, Anderson M, et al. Mapping factors that affect the uptake of digital therapeutics within health systems: scoping review. J Med Internet Res 2023; 25: e48000. - PMC - PubMed
    1. Strong K, Mathers C, Leeder Set al. et al. Preventing chronic diseases: how many lives can we save? Lancet 2005; 366: 1578–1582. - PubMed
    1. Elenko E, Underwood L, Zohar D. Defining digital medicine. Nat Biotechnol 2015; 33: 456–461. - PubMed
    1. The NICE Evidence Standards Framework for digital health and care technologies—Developing and maintaining an innovative evidence framework with global impact—Harriet Unsworth, Bernice Dillon, Lucie Collinson, Helen Powell, Mark Salmon, Tosin Oladapo, Lynda Ayiku, Gary Shield, Joanne Holden, Neelam Patel, Mark Campbell, Felix Greaves, Indra Joshi, John Powell, Alexia Tonnel, https://journals.sagepub.com/doi/full/10.1177/20552076211018617 (2021). - DOI - PMC - PubMed
    1. Lyles CR, Wachter RM, Sarkar U. Focusing on digital health equity. JAMA 2021; 326: 1795. - PubMed

LinkOut - more resources