{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:22:01Z","timestamp":1793758921897,"version":"4.6.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Telemedicine is conventionally modeled as a dyadic clinician\u2013patient encounter, yet a third party\u2014caregiver, community health worker, nurse, or increasingly an artificial intelligence (AI) conversational agent\u2014frequently participates. No principled basis exists for determining when such a third party is a genuine facilitator versus an instrument of one party, rendering cross-study comparison incommensurable and deployment decisions poorly grounded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a narrative synthesis of literature spanning triadic clinical communication, shared decision-making, and AI-mediated interaction to derive a technology-neutral conceptual framework and classification model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We propose conversational capacity, operationalized through four functions (interpret, translate, advocate, adapt), as the minimum criterion for triadic facilitation. The framework defines a structural boundary separating genuine triadic architectures (Modes A and B) from augmented dyadic models (Mode C); a five-level Conversational Capacity Spectrum classifying human and AI facilitators; and a Clinical Situation Matrix mapping architecture to morbidity complexity, patient vulnerability, and decision complexity. Advocacy emerges as the discriminating function AI is least able to perform, making it the current limiting dimension of AI facilitation. The framework generates three testable hypotheses and identifies an equity paradox whereby high-vulnerability populations most in need of human facilitation are those most likely to be assigned AI on resource grounds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Triadic telemedicine should be defined by conversational capacity rather than mere third-party presence. Replacing the binary triadic-versus-dyadic distinction with two gradable, measurable constructs is a prerequisite for cumulative research and responsible AI deployment in clinical consultations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15305627261473017","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:03:42Z","timestamp":1785773022000},"page":"1111-1120","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Conversational Capacity in Triadic Telemedicine: A Conceptual Framework and Evidence Synthesis"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9553-2074","authenticated-orcid":false,"given":"Alexander","family":"Gamus","sequence":"first","affiliation":[{"name":"Faculty of Health Systems Management, Academic Center of Law and Business, Ramat Gan, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Chodick","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel-Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoram","family":"Blachar","sequence":"additional","affiliation":[{"name":"Faculty of Health Systems Management, Academic Center of Law and Business, Ramat Gan, Israel."},{"name":"Division of Community Medical Services, Clalit Health Services, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar","family":"Shalom","sequence":"additional","affiliation":[{"name":"Faculty of Health Systems Management, Academic Center of Law and Business, Ramat Gan, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1601705"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2019.01.009"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2003539"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-022-01845-2"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.2196\/40364"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11620-w"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0000000000000694"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.2196\/20346"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0300-7"},{"key":"e_1_3_3_11_1","volume-title":"Teaching and Learning Communication Skills in Medicine","author":"Kurtz S","year":"2004","unstructured":"10.Kurtz S, , Draper J, , Silverman J. Teaching and Learning Communication Skills in Medicine. 2nd ed. Oxford: Radcliffe Medical; 2004.","edition":"2"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2009.09.034"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1061"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2012.06.014"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1957-5"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181f37d28"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2025.109383"},{"key":"e_1_3_3_18_1","volume-title":"The Oxford Handbook of Health Communication, Behavior Change, and Treatment Adherence","author":"Greene MG","year":"2013","unstructured":"17.Greene MG, , Adelman RD. Beyond the dyad: Communication in triadic (and more) medical encounters. 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