Corrigendum:

Yi HouManyao SunXueying HuangJiang NanJing GaoNan ZhuYuyu Jiang^*

• Jiangnan University, Wuxi, China

1 IntroductionAutonomy support is a key ethical principle in bioethics, as well as a fundamental aspectof nursing codes of ethics, reflecting respect for patients’ rights and values (1, 2). Self-Determination Theory (SDT) highlights that autonomy support increases patients’ motivationfor self-care behaviors, sustains health-promoting actions, and improves health outcomes (3).In clinical practice, the primary agents of autonomy support are healthcare providers (HCPs),while the recipients are patients with health problems.The concept of autonomy support has a long history and its connotation has evolved throughseveral stages. Philosophers such as Socrates, Plato, and Aristotle have all explored autonomy interms of human free will and moral responsibility (4). Kant elaborated on the support ofindividual autonomy, arguing that autonomy originates from free will (5). In healthcare, classicalautonomy theory emphasized that autonomy support was about enabling patients to “truly” make decisions and choices in line with their values and desires, driven by the power of HCPs (6, 7). Autonomy support was first introduced as a terminology in SDT. From the perspective of positive psychology, SDT proposed that autonomy support is a social environment that fosters positive feelings, allowing individuals to experience a sense of freedom (8). According to this theory, the attributes of autonomy support included choice, rationale, and empathy (9). Building upon SDT, Kayser further developed the attributes of autonomy support to include choice, rationale, empathy, collaboration, and strengths. The attributes proposed by Deci and Kayser have served as theoretical guidance in the formulation of autonomy support interventions across different contexts, providing a direct pathway to understanding the connotation of this concept.However, there is an inconsistency between the theoretical attributes of autonomy support and its practical application. In clinical practice, there is a lack of standardized guidelines for its implementation. Gillison, through a meta-analysis, outlined nine specific measures of autonomy support to guide clinical practice (3). Teixeira identified seven key strategies for autonomy support through expert consensus, providing a framework for the operationalization of autonomy support (10). In the literature, there are phenomena of “misuse” and “abuse” of the concept of autonomy support. For example, “autonomy-supportive consultation” emphasized the use of non-controlling language and respect for patient choice in face-to-face communication, highlighting partial attributes and the scenario of autonomy support (11). These show that the expression and application of this concept have become increasingly diversified, leading to confusion in clinical practice and systematic review.As more and more scenarios of healthcare service delivery gradually transition to remote settings, these challenges may be further exacerbated. And in this setting, autonomy support is no longer only provided by HCPs through face-to-face communication, but more is automatically provided by HCPs preset procedures or agents according to the real-time environment (such as online website, automatic monitoring equipment, robots, etc.) (12–14). Moreover, due to the use of information and communication technology (ICT), the sources of health information provided by autonomy support are much broader and no longer solely dependent on the teaching of HCPs (15). Meanwhile, autonomy support in telehealth also brings a series of new problems for patients such as information overload, data protection, cybersecurity, etc. (16). Several studies have demonstrated that autonomy support strategies formulated based on Deci or Kayser’s attributes, when directly applied in remote settings, have significantly less positive impact on patients (17–19). Pettersson’s qualitative research also found that the characteristics of autonomy support have changed compared with previous studies (15). Rodgers proposed that concept is a dynamic process of evolution and transformation over time, influenced by various underlying factors including social environment, views and values, and life style (20). Consequently, it is necessary to clarify the attributes of autonomy support in telehealth in order to evade conflicts between care services and the diverse needs of patients, as well as the care service scenarios. This will reduce the potential adverse outcomes arising from a mismatch between supply and demand, and thereby significantly reducing the likelihood of these adverse implications of quality of life and health, while simultaneously supporting patient common rights of autonomy and dignity.This study aimed to clarify the attributes, antecedents, and consequences of autonomy support in telehealth and to construct a conceptual model using Rodgers’ evolutionary approach, aiding HCPs in understanding its connotation in telehealth and guiding the design of telehealth services.