Research paper
Digital audio recordings improve the outcomes of patient consultations: A randomised cluster trial

https://doi.org/10.1016/j.pec.2016.08.029Get rights and content

Highlights

  • The probability of fulfilling patients’ information needs increases.

  • Patients’ self-perceived recall and understanding of information improves.

  • Patients’ experience of being involved improves.

  • Patients’ satisfaction with treatment and their relationship with the health professional increases.

Abstract

Objectives

To investigate the effects on patients’ outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL).

Methods

This is a three-armed randomised controlled cluster trial. One group of patients received standard care, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires.

Results

A total of 4349 patients participated in the study. DAR significantly increased the probability of fulfilling the participants’ self-perceived information needs by 4.1% to 6.3%, particularly with regard to test results (OR = 1.41, 95%CI: 1.14-1.74, p = 0.001) and treatment options (OR = 1.39, 95%CI: 1.13-1.71, p = 0.002). Additionally, the interventions positively influenced the participants’ satisfaction with the treatment, their relationship with the health professional, and their experience of being involved in the decision-making.

Conclusion

Providing outpatients with a QPL and DAR of their consultation positively influences the patients’ perception of having adequate information after the consultation.

Practice implications

The implementation of a QPL and audio recording of consultations should be considered in routine practice.

Introduction

Communication between patients and health professionals is a cornerstone in modern healthcare and is a necessity for adequate treatment as well as a positive patient experience. As in other Western countries [1], [2], the Danish Healthcare System encourages patients to participate in decision-making [3] and patients often request involvement in decision-making concerning their care [4]. To facilitate successful participation in decision making, some basic assumptions must be met: patients need to receive relevant and sufficient information, understand and retain complex information [5], and evaluate and employ this in their communication with health professionals [6]. Despite government policies and legal rights on patient information and participation [7], communication aspects constitute a considerable part of patient complaints [8]. Along with the results from healthcare evaluations [9], patient complaints reveal a potential gap between the information given by health professionals and patients’ understandings. A simple explanation could be that patients tend to forget a considerable amount of the medical information provided [5]. Disadvantageous circumstances caused by the disease itself or stressful information might also be a factor. In recent years, several initiatives have been made to improve the communication between patients and health professionals. Some research focused on health professionals, identified a positive impact of communication skills training [10], [11]. Other studies have focused on improving patients’ skills and knowledge, e.g., through preparation prior to the consultation [12], [13], provision of access to different information sources after the consultation such as summary letters [14], or by giving take-home audio recordings of the consultation [15], [16]. The latter has proven beneficial for patients and their relatives in terms of satisfaction [14], [17], [18], [19], participation [20], understanding, and recall [18], [21], [22], [23], [24], [25], [26]].

Likewise, providing patients with a Question Prompt List (QPL) as preparation for the consultation has shown minor but positive tendencies on similar outcomes, although results are ambiguous [27], [28], [29], [30].

However, most studies have been limited to oncology settings and “bad news” consultations [14], [15], [17]. Interventions have primarily been investigated independently in efficacy studies, stressing the need for a study investigating the interventions in a broader clinical setting with a combination of interventions.

The objective of this study was to investigate the effects of providing patients with a Digital Audio Recording (DAR) of their outpatient consultation either alone or in combination with a Question Prompt List (QPL) given prior to the consultation. This paper will address the following research hypotheses: Providing patients with a DAR of their consultation will improve their post-consultation information level, and adding the QPL as a supplement to the DAR will further improve patients’ self-perceived information level.

Section snippets

Setting

The study was conducted in four different outpatient clinics, namely Paediatrics, Orthopaedics, Internal Medicine, and Urology, at a Danish regional hospital. When selecting the clinics, we strived to achieve diversity in disease duration, severity, and complexity by including both surgical and medical consultations, as well as paediatric and adult clinics. The department heads selected, 17 nurses, 17 physicians, and 15 surgeons to conduct the consultations in the randomised trial. To ensure

Participant flow

A total of 4349 patients participated in the study (Fig. 1). The two most common reasons for patients not receiving a recording were forgetfulness among the health professionals and patients declining participation. A comparison of the patients who declined participation with participants showed minor variations in age and gender; however, the proportion of patients attending the clinic three times or more was significantly higher among patients declining to participate (62%) than among

Discussion

This study investigates the effects of a digital audio recording technology in routine practice and the effects of combining the recording with preparing patients for their consultation. Our results showed that providing outpatients with an audio recording of their consultation increased the chance of fulfilling the participants’ self-perceived information needs in five key areas regarding treatment and care. The results corroborate those reported in two studies by Hack et al. [25], [26] in

Competing interests

No competing interests.

Funding

The funders of this study were the Region of Southern Denmark; Lillebaelt Hospital; the University of Southern Denmark; TrygFonden (110631); the Novo Nordisk Foundation (1015037); and the Lundbeck Foundation (65/2011). None of the funding sources were involved in the research.

Acknowledgements

We are grateful to all patients, outpatient clinics and health professionals for their contribution to this research.

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