Ethics of Telerehabilitation in Supportive Cancer Care Through a Responsible Innovation Lens.
13 affiliations
- 1Centre for Ethics and Law in the Life Sciences, Leibniz University Hannover, Hannover, Lower Saxony, Germany.
- 2Independent Researcher, Boston, MA, United States.
- 3OncoMove, Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal.
- 4Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Maia, Portugal.
- 5Exercise Oncology Research Group, Department of Medical Oncology, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
- 6National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and the Heidelberg University Hospital, Heidelberg, Germany.
- 7Division of Physical Activity, Cancer Prevention and Survivorship, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany.
- 8Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden.
- 9Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- 10Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
- 11Cabrini Cancer Institute, Cabrini Health, Melbourne, Victoria, Australia.
- 12Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- 13Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands, +31 20512 2480.
Abstract
Unlabelled
In recent years, remote exercise services ("telerehabilitation") have been increasingly explored and implemented, including in supportive cancer care, on the promise of greater convenience, access independent of geographic location, reduced infection risk, and cost savings. Ethical commentary on telehealth in general is substantial, but sustained discussion of questions specific to telerehabilitation remains comparatively sparse. As contributors to PREFERBALE-II, a European Union-funded project evaluating live-remote exercise for people recovering from cancer treatment, we sought practical guidance on how to deliver such services responsibly, and found little to work with. This prompted this viewpoint, which sets out our own position as researchers and clinicians engaged in this work. We draw on a purposive sample of professional guidance documents, which were assembled through our professional networks and a supplementary web search, and on a narrative reading of qualitative studies chosen to represent accounts of benefits as well as burdens. We read these documents through an analytical lens of responsible innovation. We make 3 arguments. First, the ethical content of current telerehabilitation guidance is largely confined to the products and processes of innovation, covering safety, privacy, consent, and compliance, while the question of purpose, that is, whether, for whom, and why remote rehabilitation should be offered at all, is left largely unasked. Anticipation appears only implicitly, and reflexivity, inclusion, and responsiveness barely at all. Responsibility is repeatedly delegated to individual professionals without commensurate structural support. Second, the situated experience of users and professionals forms part of the ethics of telerehabilitation and is not merely data to be assessed. Reported benefits and burdens depend on social context, including age, digital literacy, connectivity, caregiver availability, language, and sensory or cognitive impairment, so an equity claim made for the modality in general may not hold for the individual patient. Third, the ethics of telerehabilitation consequently has to be institutionalized across 3 overlapping domains: the interpersonal and experiential quality of remote care, the legal and institutional conditions of delivery, and the positioning of telerehabilitation within health systems. We address these arguments primarily to rehabilitation professionals and the associations and standard-setting bodies that issue guidance for them, and secondarily to digital health and ethical, legal, and social implications researchers, policymakers, and health-system decision-makers who commission or implement such services. We offer an agenda for a broader ethics conversation across professional societies, curricula, and affected publics, together with observations from a consortium put forward as hypotheses for study.
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BibTeX
@article{lorenz2026ethics,
title = {{Ethics of Telerehabilitation in Supportive Cancer Care Through a Responsible Innovation Lens.}},
author = {Maria C Lorenz and Matthew Sample and Alberto J Alves and Jana Müller and Karen Steindorf and Yvonne Wengström and Eva M Zopf and Anne M May and Martijn M Stuiver},
journal = {Journal of medical Internet research},
year = {2026},
month = oct,
doi = {10.2196/94505},
url = {https://europepmc.org/article/MED/42912965},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ethics of Telerehabilitation in Supportive Cancer Care Through a Responsible Innovation Lens.
AU - Maria C Lorenz
AU - Matthew Sample
AU - Alberto J Alves
AU - Jana Müller
AU - Karen Steindorf
AU - Yvonne Wengström
AU - Eva M Zopf
AU - Anne M May
AU - Martijn M Stuiver
PY - 2026
DA - 2026/10/22
JO - Journal of medical Internet research
DO - 10.2196/94505
UR - https://europepmc.org/article/MED/42912965
AB - Unlabelled In recent years, remote exercise services ("telerehabilitation") have been increasingly explored and implemented, including in supportive cancer care, on the promise of greater convenience, access independent of geographic location, reduced infection risk, and cost savings. Ethical commentary on telehealth in general is substantial, but sustained discussion of questions specific to telerehabilitation remains comparatively sparse. As contributors to PREFERBALE-II, a European Union-funded project evaluating live-remote exercise for people recovering from cancer treatment, we sought practical guidance on how to deliver such services responsibly, and found little to work with. This prompted this viewpoint, which sets out our own position as researchers and clinicians engaged in this work. We draw on a purposive sample of professional guidance documents, which were assembled through our professional networks and a supplementary web search, and on a narrative reading of qualitative studies chosen to represent accounts of benefits as well as burdens. We read these documents through an analytical lens of responsible innovation. We make 3 arguments. First, the ethical content of current telerehabilitation guidance is largely confined to the products and processes of innovation, covering safety, privacy, consent, and compliance, while the question of purpose, that is, whether, for whom, and why remote rehabilitation should be offered at all, is left largely unasked. Anticipation appears only implicitly, and reflexivity, inclusion, and responsiveness barely at all. Responsibility is repeatedly delegated to individual professionals without commensurate structural support. Second, the situated experience of users and professionals forms part of the ethics of telerehabilitation and is not merely data to be assessed. Reported benefits and burdens depend on social context, including age, digital literacy, connectivity, caregiver availability, language, and sensory or cognitive impairment, so an equity claim made for the modality in general may not hold for the individual patient. Third, the ethics of telerehabilitation consequently has to be institutionalized across 3 overlapping domains: the interpersonal and experiential quality of remote care, the legal and institutional conditions of delivery, and the positioning of telerehabilitation within health systems. We address these arguments primarily to rehabilitation professionals and the associations and standard-setting bodies that issue guidance for them, and secondarily to digital health and ethical, legal, and social implications researchers, policymakers, and health-system decision-makers who commission or implement such services. We offer an agenda for a broader ethics conversation across professional societies, curricula, and affected publics, together with observations from a consortium put forward as hypotheses for study.
SN - 1439-4456
SN - 1438-8871
ER -