Mapping social implications of wearables to monitor physical activity in palliative care - a qualitative approach

Reduced physical activity is common among patients receiving palliative care. Wearables and other measurement devices offer opportunities to objectively monitor activity and support clinical decision-making and patient motivation. However, integrating such technologies into palliative care may affect care delivery, including routines, interactions and underlying principles. Given the strong emphasis on interpersonal relationships and patient-centeredness in this setting, wearables may entail specific social implications. This study therefore aims to map the social implications of using wearables to monitor physical activity in palliative care.

Based on the CARE-HOUSE Framework, developed to conceptualise the social implications associated with digital health technologies, we investigated the potential social implications of using wearables (smartwatches and accelerometers) to monitor physical activity. Focus groups were conducted with palliative care researchers with clinical experience. After presenting background information on wearable activity monitors, participants were prompted to discuss prospective benefits, risks and unknown effects on stakeholders, interactions, social roles, and tasks in the context of healthcare practice. Data was analysed using content structuring analysis.

We conducted two focus groups with palliative care researchers with clinical experience (each n = 4; ~50 min duration) to map social implications of wearable technologies used to monitor physical activity in palliative care. The findings showed that wearable technologies introduce new tasks and organizational requirements in clinical practice. They may increase patients' self-efficacy and motivation to remain active but can also provoke feelings of surveillance and influence interactions between patients, relatives, and healthcare professionals. Objective physical activity data may transform medical consultations by supporting assessment, and care planning. Furthermore, wearable technologies may support holistic palliative care by promoting physical activity, and therefore autonomy, and quality of life.

Mapping the social implications of wearables to monitor activity can inform their implementation in palliative care. Addressing these implications is important to ensure that the devices support patient well-being. Future research should focus on translating these insights into practical guidance and incorporate the perspectives of both clinicians and patients.