Consultation Recording: What Is the Added Value for Patients Aged 50 Years and Over? A Systematic Review

Shared decision-making in end-of-life care for end-stage renal disease patients: nephrologists' views and attitudes

BACKGROUND

The term end-stage renal disease (ESRD) refers to the final stage of chronic kidney disease. Not all ESRD patients are suitable for dialysis treatment, which despite its advantages, is not without risks. Shared nephrologist-patient decision-making could be beneficial at this stage, yet little is known about such practices in Israel. This study aimed at examining the practice of shared decision-making (SDM) between nephrologists and ESRD patients in Israel, while exploring related conflicts, ethical dilemmas, and considerations.

METHODS

The descriptive-quantitative approach applied in this study included a validated questionnaire for nephrologists, based on Emanual and Emanual (1992). The survey, which was distributed via social-media platforms and snowball sampling, was completed by 169 nephrologists. Data analysis included t-tests for independent samples, f-tests for analysis of variance, and t-tests and f-tests for independence. Descriptive analysis examined attitudes towards SDM in end-of-life care for ESRD patients.

RESULTS

The findings show that the research sample did not include nephrologists who typically act according to the paternalistic decision-making style. Rather, 53% of the respondents were found to act in line with the informative decision-making style, while 47% act according to the interpretive decision-making style. Almost 70% of all respondents reported their discussing quality-of-life with patients; 63.4% provide prognostic assessments; 61.5% inquire about the patient's desired place of death; 58.6% ask about advance directives or power-of-attorney; and 57.4% inquire about cultural and religious beliefs in end-of-life treatment. Additionally, informative nephrologists tend to promote the patients' autonomy over their health (P < 0.001); they are also in favor of conservative treatment, compared to paternalistic and interpretive nephrologists, and use less invasive methods than other nephrologists (P = 0.02).

CONCLUSIONS

Nephrologists in Israel only partially pursue an SDM model, which has the potential to improve quality-of-care for ESRD patients and their families. SDM programs should be developed and implemented for increasing such practices among nephrologists, thereby expanding the possibilities for providing conservative care at end-of-life.

Attitudes and experiences of cancer patients toward the provision of audio recordings of their own medical encounter: a cross-sectional online survey

Background

The provision of audio recordings of their own medical encounters to patients, termed consultation recordings, has demonstrated promising benefits, particularly in addressing information needs of cancer patients. While this intervention has been explored globally, there is limited research specific to Germany. This study investigates the attitudes and experiences of cancer patients in Germany toward consultation recordings.

Methods

We conducted a nationwide cross-sectional quantitative online survey, informed by semi-structured interviews with cancer patients. The survey assessed participants' attitudes, experiences and desire for consultation recordings in the future. The data was analyzed using descriptive statistics and subgroup analyses.

Results

A total of 287 adult cancer patients participated. An overwhelming majority (92%) expressed a (very) positive attitude. Overall, participants strongly endorsed the anticipated benefits of the intervention, such as improved recall and enhanced understanding. Some participants expressed concerns that physicians might feel pressured and could become more reserved in their interactions with the use of such recordings. While a small proportion (5%) had prior experience with audio recording medical encounters, the majority (92%) expressed interest in having consultation recordings in the future.

Discussion

We observed positive attitudes of cancer patients in Germany toward consultation recordings, paralleling international research findings. Despite limited experiences, participants acknowledged the potential benefits of the intervention, particularly related to recalling and comprehending information from medical encounters. Our findings suggest that the potential of the intervention is currently underutilized in German cancer care. While acknowledging the possibility of a positive bias in our results, we conclude that this study represents an initial exploration of the intervention's potential within the German cancer care context, laying the groundwork for its further evaluation.

Beyond Recording the Clinical Discussion: A Qualitative Study into Patient-Led Recordings in Hospital

Patient-led recording occurs when a patient records a clinical encounter with their smart device. Understanding patient-led recording is important in ensuring a safe and patient-centered response to this behavior. This exploratory study provides insight into the patient perspective of patient-led recordings. We conducted 20 semistructured interviews with hospital and health service patients. The interview data was analyzed using thematic analysis. We identified three themes relating to patient-led recordings, including patient engagement, psychosocial, and health service. Findings suggest that health services move beyond querying the permissibility of recording and consider how to maximize the benefits of recording while reducing the risk of harm. Patients and clinicians need to be made aware of the potential broader psychosocial benefits of recording a clinical encounter during hospital admission. These results point to an urgent need for health services to develop policies and resources that support clinicians to work within a culture of recording.

The French General Population's Perception of New Information and Communication Technologies for Medical Consultations: National Survey

BACKGROUND

The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples' current experience of health care.

OBJECTIVE

This study aimed to determine the French general population's perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception.

METHODS

Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors.

RESULTS

The majority (1239/2003, 62%) of respondents considered the use of mHealth apps useful, while only 27.6% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (≤ 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95% CI 1.31-2.17; mHealth apps: aOR 1.88, 95% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist.

CONCLUSIONS

There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all.

Dealing with the Vicissitudes and Abject Consequences of Head and Neck Cancer: A Vital Role for Psycho-Oncology

Patients with head and neck cancer face important life-altering effects in appearance and function, affecting distress and quality of life and requiring the involvement of a multidisciplinary team. Psycho-oncology makes an important contribution to the field, as head and neck cancers carry a huge adaptational toll. To illustrate the value of this discipline, we report two cases of patients with advanced head and neck cancer for which the treatment-related body changes were of major significance. A commentary by the treating surgeons and psycho-oncologists precedes a general discussion about the clinical management of such patients. The article outlines strategies to address health literacy, doctor–patient communication, treatment decision-making, and emotional distress; placing the person at the center of oncological care. It calls for the broad application of principles of psychological first aid by healthcare professionals in oncology.

Improving preoperative breast reconstruction consultations: a qualitative study on the impact of personalised audio-recordings

Background

To investigate the value of audio-recordings in aiding patient understanding and recall of preoperative breast reconstruction information.

Methods

This was a prospective cohort study. Participants were randomly allocated into either a recording group who were offered the opportunity to record their breast reconstruction explanation of surgery, or a standard information package group who received standard care. The value of having an audio-recording was assessed by semi-structured interviews and analysis of recurring themes.

Results

Between 21/2/19 and 19/3/20, 32 women attending consultations for breast reconstruction consented to participate in the study, 17 were randomly assigned to the recording group and 15 the standard information package group. Twenty-eight of the 32 participants completed qualitative interviews. All participants agreed that audio-recordings were a beneficial resource which allowed them to have a better understanding of the concepts discussed. Commonly reported themes included the ability to listen to the recording multiple times to refresh memory, as well as usefulness in helping to inform other family members. Participants also reported increased levels of trust in their clinician for allowing the audio-recordings. Very few participants raised any medico-legal implications of the recordings, their focus was more on the potential of the audio-recordings to alleviate the overwhelming nature of a pre-operative breast reconstruction consultation.

Conclusions

There was a positive response from participants to the use of audio-recordings in the setting of breast reconstruction consultations. These types of recordings could potentially be used in other complex appointments where detailed information is discussed, with similar success.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01534-8.

'Mind if I record this?' Patients making audio-visual recordings of consultations: a survey of surgeons' experiences

INTRODUCTION

Audio-visual recordings made by patients of their clinical encounters are increasingly common. This may be done with or without their doctors' knowledge or consent and is considered admissible legal evidence. Many surgeons may feel uncomfortable with being recorded and lack knowledge regarding the legal implications. The aim of this study was to gauge how surgeons react to being recorded, and what specific medico-legal insight they have regarding these matters.

METHODS

In total, 150 surveys were distributed to surgeons in two hospitals in South Wales by email, Survey Monkey and paper copy between 28 October 2019 and 9 March 2020. The survey was anonymous and recorded level of training, as well as four simple questions regarding how surgeons may react to being recorded and what they felt their legal rights were.

RESULTS

There were 91 respondents: 28 consultants, 36 registrars and 27 junior surgical trainees. Of the respondents, 56% were uncomfortable with being recorded and 23% would stop a consultation if their patient insisted on recording it. These issues were most marked for junior surgical trainees. Sixty-two per cent of respondents were unaware of their legal rights and 21% believed they were legally able to refuse to continue a consultation. This belief was particularly marked among consultants.

CONCLUSION

Many surgeons are uncomfortable with being recorded and lack knowledge regarding their medico-legal standing. Education and guidance from the Royal Colleges would help address this issue and avoid misunderstanding when surgeons are faced with these potentially difficult scenarios.