A systematic concept analysis of ‘technology dependent’: challenging the terminology

European Journal of Pediatrics https://doi.org/10.1007/s00431-020-03737-x REVIEW A systematic concept analysis of ‘technology dependent’: challenging the terminology Maria Brenner 1 & Denise Alexander 1 & Mary Brigid Quirke 1 & Jessica Eustace-Cook 2 & Piet Leroy 3 & Jay Berry 4 & Martina Healy 5,6 & Carmel Doyle 1 & Kate Masterson 1,7 Received: 5 May 2020 / Revised: 22 June 2020 / Accepted: 9 July 2020 # The Author(s) 2020 Abstract There are an increasing number of children who are dependent on medical technology to sustain their lives. Although significant research on this issue is taking place, the terminology used is variable and the concept of technology dependence is ill-defined. A systematic concept analysis was conducted examining the attributes, antecedents, and consequences of the concept of technology dependent, as portrayed in the literature. We found that this concept refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide ranging sequelae for the child and family, and health and social care delivery. Conclusion: The term technology dependent is increasingly redundant. It objectifies a heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. What is Known: • There are an increasing number of children who require medical technology to sustain their life, commonly referred to as technology dependent. This concept analysis critically analyses the relevance of the term technology dependent which is in use for over 30 years. What is New: • Technology dependency refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide-ranging sequelae for the child and family, and health and social care delivery. • This term is increasingly redundant and does not serve the heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. More appropriate child-centred terminology will be determined within the TechChild project. Keywords Child . Complex needs . Concept analysis . Family . Technology dependence Communicated by Daniele De Luca * Maria Brenner Jay Berry Denise Alexander Martina Healy Mary Brigid Quirke Carmel Doyle Jessica Eustace-Cook Piet Leroy Kate Masterson Extended author information available on the last page of the article Eur J Pediatr Abbreviations ICD Implantable cardioverter defibrillators HRQoL Health-related quality of life PICU Paediatric intensive care unit Introduction There are an increasing number of children who require medical technology to sustain their life [1–4] and, in response, an expanding array of medical technology available. This paper analyses the concept of ‘technology dependent’, the term commonly used to refer to these children. The current prevalence and rate of increase in the number of children who are technology dependent is difficult to determine as they depend on a number of interrelated factors including: the prevalence of particular conditions; medical and surgical interventions chosen; and finance and policies for care delivery across and within countries [5–7]. The term technology dependent stems primarily from the phrase ‘technology dependence’ which was coined 30 years ago by the Office of Technology Assessment (US) [8], describing ‘a medical device to compensate for the loss of a vital body function and substantial ongoing nursing care to avert death or further disability’. To the best of our knowledge, this is the first systematic concept analysis to examine the contemporary relevance and utility of this terminology as it is currently portrayed in the literature. This is important for two key reasons: the array of medical technology now available means that the broad term of ‘technology dependent’ has the potential to conjure up a multitude of clinical scenarios; and the objectifying nomenclature does not reflect a child-centric approach. This paper is part of a larger body of research, the TechChild project, funded by the European Research Council. The purpose of this research is to explore influences on the initiation of technology dependence required to sustain a child’s life and to identify more appropriate child-centred terminology in an evidenced-based manner. An evolutionary concept analysis was employed as it seeks to examine the cluster of key characteristics that through common use, collectively form the real definition of a concept [9]. According to Rodgers [9], it is necessary to understand the antecedents (phenomena usually found prior to concept occurrence), the attributes of the concept, and the consequences that follow as a result. Without a clear conceptual foundation, there is an ambiguity which in turn can compromise the quality of research or theory construction as the area develops [10]. Methods Rodgers’ evolutionary method [9] was used to systematically analyse the concept of technology dependence in the scientific literature. This method is particularly well suited to this issue given the changing and dynamic nature of advances in medical technology. Alternative approaches to concept analysis are founded in a realist paradigm, in which a reductionist approach focuses on defining a concept as a static entity. Rodgers’ relativist stance, in comparison, seeks to identify how a concept is portrayed in the literature using an inductive approach, while acknowledging that any understanding of a concept is evolutionary as it is influenced by dynamic contextual factors, which may be disciplinary, cultural, or theoretical [9]. Rodgers’ approach to concept analysis includes a set of core activities, which can be carried out simultaneously and not necessarily in a linear manner (Table 1). Analysis seeks to identify what is common, the purpose of which is to identify data that is relevant to the attributes of the concept and its contextual features. Thematic analysis identifies major themes presented in the literature. Data sources and search strategy A three-strand approach was used to create a systematic search. An initial scoping search was run in PubMed and CINAHL to identify appropriate control language using MeSH and CINAHL headings. Control language is the language of the topic established at the start of a systematic search, against which other terms which emerge are mapped against. This includes developing a list of synonyms and consideration of reference and non-reference words for the search. A secondary scoping search was then conducted identifying appropriate keywords related to the following: technology dependence, technology dependent, complex care needs, complex medica (...truncated)