Health Care and Health PromotionWhen patients take the initiative to audio-record a clinical consultation
Introduction
While healthcare professionals (HCPs) are responsible for facilitating the consultation process, patients are increasingly expected to be informed participants and to be able to make conscious decisions [1]. Clearly, the complex nature of medical encounters and the often vulnerable and emotional position of patients make this role challenging for them, which is evident in oncology care [2], [3], [4]. In 2007, Epstein and Street stressed the need to support patients in the communication process [5]. Giving patients an audio-recording of the consultation to replay, has proven to be an effective approach in this context. Studies in the oncology setting reveal that patients highly value audio-recordings, the majority benefit from listening to the recordings, and they provide support in achieving effective medical communication [6], [7], [8], [9], [10]. Moreover, it improves information recall [11], [12], [13], gives a clearer understanding of treatment options [14], [15] and induces more active engagement in treatment decisions [15], [16].
Despite these benefits, routinely providing audio-recordings to patients has not yet become common practice in oncology clinics [6], [8]. Practical issues like funding and logistics, as well as HCPs’ antagonistic views seem to impede implementation [17], [18]. These views relate for example to the perceived intrusive nature of recordings, perceived ‘risks’ (medico-legally), the belief that patients do not benefit from listing back to a consultation or the belief that it is confusing for patients. However, current developments have led to a resurgence in the use of audio-recordings in clinical practice, but from a different perspective. Whereas previously the HCP facilitated and provided the recording, now patients take the initiative. Smartphones and tablets enable patients to make audio-recordings in an easy and accessible way and in the Netherlands, patient associations have started to encourage patients to record their clinical consultations. Online discussions between HCPs reveal that (also in other countries) HCPs are confronted with these developments in clinical practice [19], [20], [21].
From an organisational perspective, the administrative support, logistics, and financial resources may be simplified when patients take the initiative to record the clinical consultation, rather than HCPs. It may be far easier to obtain audio-recordings across medical specialties (in the case of severe or chronic conditions) when the patient is in control. This approach also fits with the increased focus on patient engagement and transparency in healthcare. However, the use of consultation audio-recordings made on the initiative of patients, will only be feasible when both parties (HCPs and patients) endorse this new approach. But what are the opinions of HCPs on being recorded on patients’ request?
Recent articles about patient initiated recordings share personal experiences, opinions and case studies that mainly describe the covert recording of clinical encounters [19], [20], [21].To follow the developments in the use of open (rather than covert) consultation audio-recordings and to find out how they can advance patient–professional communication in oncology care, we set up an explorative study. The study was guided by the following questions:
- 1.
What are the current experiences with consultation audio-recordings of Dutch HCPs in oncology care?
- 2.
What are the perceived risks and perceived influence of recording a consultation?
- 3.
What are the views and perspectives that may influence the use of the audio-recordings made on patients’ request?
Section snippets
Participants and design
An online survey was set up, based on previous research related to consultation audio-recordings [17]. Dutch hospitals and associations for HCPs in oncology care were asked to circulate the questionnaire link to their employees or members; i.e. physicians, nurse practitioners and nurses. In addition, social media (Twitter and LinkedIn) were used to publicize the survey. The questionnaire was available online from April to June 2015 and started with screening questions (gender, age, occupation,
Sample characteristics and experience
The respondents consisted of 215 HCPs in oncology care: 123 physicians and 92 nurse and nurse practitioners. Nurse and nurse practitioners were combined into a single group during analysis. A minority of the respondents had experience with consultation audio-recordings facilitated by their hospital (N = 37, 17%). The others (N = 178, 83%) were questioned about their experience with audio-recordings initiated by patients. Two-thirds of this group (N = 116) had been confronted at least once by a
Summary of findings
In this explorative study, 215 HCPs in oncology care shared their experiences with consultation audio-recordings and their views on the use and implementation of audio-recordings. The number of reactions to the questionnaire and the detailed, sometimes strongly worded answers demonstrate that consultation audio-recordings are a topical issue. The majority of the respondents did have experience with consultation audio-recordings. Despite existing concerns, most respondents (would) cooperate with
Conclusion
Overall, Dutch HCPs in oncology care seem to support patient initiated consultation audio-recordings but many concerns exist and need to be tackled. While the majority cooperates when their patient asks to record the consultation, the concerns are for a number of respondents reason enough not to cooperate.
Author contributions
All authors contributed to the design of the study. IB and BL conducted the data processing. IB analysed the data and wrote the first manuscript in concept. All authors reviewed and contributed to writing the final manuscript
Funding
Dutch Cancer Society grant number – NIVEL 2010-4747;
Conflict of interest
None.
Ethics
The study does not fall within the remit of the Medical Research Involving Human Subjects Act (WMO). We complied with Dutch research ethics in performing the study that we described.
Acknowledgements
We thank the respondents for completing the questionnaire. We are grateful to the Alpe d’HuZes program of the Dutch Cancer Society for their financial support.
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