Providing recording of clinical consultation to patients

One of the earliest suggestions that patients might benefit by the provision of audio-recordings of clinical consultations to patients was by Hugh Butt in 1977.

The Objective of the research paper is to show the benefits of providing patients with recorded clinical consultations have been mostly investigated in oncology settings, generally demonstrating positive outcomes. There has been limited synthesis of evidence about the practice in wider context. Our aim was to summarize, in a scoping review, the evidence about providing consultation recordings to patients.

The upside:

He noted the possibility that the method could lead to a ‘‘better physician-patient communication’’ [1]. Since the late 1970s onwards, there have been studies of this process of giving recordings to patients, although none have been comprehensive in terms of their scope. Existing specialty-focused studies have noted the benefits of providing recordings of clinical consultations to patients. These include

  1. Better information recall by patients [2,3], and the
  2. View that having access to recordings support them when they wish to discuss their condition with family and friends [4,5].
  3. Patients also report clearer understanding of treatment options [4,6] 
  4. More active engagement in treatment decisions [6,7].

The downside:

Studies also mention the problems encountered when undertaking these efforts. Explaining the presence of a recording device disrupts the normal flow of the clinic, consent is required (not in all states), and technical problems arise, especially when the technology was much more cumbersome that current digital recording devices. However, previous reviews have focused on specific clinical areas, namely, oncology [8–11] and pediatrics [12]. We considered it important to get an overview.

Results:

Of 5492 abstracts, 33 studies met the inclusion criteria. Between 53.6% and 100% (72% weighted average) of patients listened to recorded consultations. In 60% of reviewed studies patients shared the audio-recordings with others. Six themes identified in the study provided evidence for enhanced information recall and understanding by patients, and positive reactions to receiving recorded consultations. There has been limited investigation into the views of providers and organizations.

Deeper dive into results:

1. Use of recordings by patients - 72% (weighted average) listened to the audio-recorded consultation [2–7,22–42,43,44] - 68% (weighted average) shared recording with family, friends and doctors - Audio-recordings were listened to 2–50 times

2. Impact on information recall and understanding - 22 studies (67%) reported improved information recall and understanding out of 25 measuring the impact on recall and understanding [2–6,22,23,25–29,31–39,41,42,44,45] - Audio-recordings helped with recall of information on disease and treatment, side effects, implication, prognosis and available options - Patients heard ‘‘new’’ and forgotten information

3. Patient acceptance of recordings of clinical consultations - 26 studies (79%) of studies reported positive patient perceptions (e.g. helped in adjusting emotionally and psychologically to their illness) [2,3,5,22–30,32–45] - Some patients expressed desire to have more consultations audio-recorded - Some would recommend to others

4. Benefits for specific patient population - Patients with lower SES, older age, impaired abilities and overwhelmed with stress may benefit more [2,3,22,36]

5. Provider divergence - Impact of clinical specialization on provider perceptions mixed [19–26] - Concerns about free flow of consultation, patient confidentiality

6. Organizational factors - Time requirements and workflow disruption most frequently discussed [6,19,20,23,27,44] - Medico-legal aspects not sufficiently investigated a Results which are not quantified are drawn from qualitative studies or thematic analysis. 302 M. Tsulukidze et al. / Patient Education and Counseling 95 (2014) 297–304 consultations including notifying the patients and managing the devices, and (4) providing organizational clarity about medico-legal aspects of recording consultations.

Conclusion:

Patients place a high value on receiving audio-recordings of clinical consultations and majority benefit from listening to consultation recordings. :) 

Practice implications:

Further investigation of the ethical, practical and medico-legal implications of routinely providing recorded consultations is needed.

Check out the full research paper below.

 Providing recording of clinical consultation to patients – A highly valued but underutilized intervention: A scoping review

This work was supported by the Dartmouth Center for Health Care Delivery Science.

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