Considering ethical issues in evaluation studies on remote patient monitoring for cancer and cardiovascular diseases: a scoping review

Introduction Considering ethical issues is increasingly recognized as a core component of robust digital health evaluations. However, no agreed-upon standard guides evaluators on how such issues should be systematically identified, examined, and reported. Moreover, the extent to which ethical issues are addressed in digital health evaluation studies remains unclear, as existing reviews have not examined this question in sufficient depth. This scoping review aims to address this gap by exploring how ethical issues are addressed and reported in evaluation research on remote patient monitoring (RPM) technologies in cancer and cardiovascular disease care. Methods This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. MEDLINE, Embase, CINAHL, PsycINFO, SocINDEX, and the Philosopher's Index were searched, complemented by a Google Scholar search for additional peer-reviewed studies. Eligible sources included original evaluation studies of non-fully automated RPM requiring active patient or caregiver engagement and bidirectional interaction with healthcare providers in cancer and cardiovascular disease care. A protocol-based extraction template was iteratively refined, and a mixed deductive–inductive approach was applied. Data were analyzed using basic qualitative content analysis. Results Ethically relevant issues were grouped into four analytical categories: Integrity in Research and Development , Ambivalent Impacts of RPM , Justice and Equity , and Data Privacy and Security . Across these categories, ethically relevant issues were frequently reported, but their treatment often remained descriptive, while normative or critical reflection on their ethical implications was much less visible. Explicit references to ethics were largely confined to statements of ethics approval, providing little insight into the underlying ethical reflection. Furthermore, an emphasis on positive findings was identified, while reflections on the ethical implications for non-beneficiaries remained limited. Similarly, reporting of data privacy and security measures related to the evaluated digital health tools was often insufficient. Discussion Ethically relevant issues were evident, but explicit and systematic reflection on their ethical implications was less visible in the reporting. More reflective ethical engagement, supported by interdisciplinary collaboration and shared empirical-ethical guidance, may foster more ethically informed digital health research and practice.