Background
Specific objectives of this review
Example/comments | |
---|---|
Time between video recorded event and SR
| Participant recall of events will be greater immediately after the interview. |
Strength of stimulus
| Video is an example of a strong stimulus, but the strength of stimulus may be increased still further by additional stimulus for recall e.g. transcripts of consultation. The greater strength of stimulus, the more enhanced the recall will be. |
Procedural structure of accompanying interview
| A structured interview is an example of high procedural structure and will result in more specific information relative to the research question. |
A low structure approach would involve minimal questioning and the use only of neutral prompts during playback e.g. “what were you thinking then?”. This method may be more suitable where the research question concerns cognitive processes at the time of the interview and is less likely to result in researcher contamination. | |
Initiation of recall event
| The researcher may lead recall by asking the participant to comment on areas of interest to the researcher, or the participant may be asked to comment on aspects of their choice. Again, researcher initiated events may encourage more reflection than recall alone. |
Relationship between video recorded event and line of inquiry
| During a VSR interview, a participant may be questioned only on events that occurred during the video, described as a ‘concrete relationship to action’. However, they may be asked to abstract to other general events, an example of a ‘non-specific relationship to action’. In this instance, their recall may not be as great. |
Participant training
| Participants may need training and practice if asked to comment on stimulus in an unstructured way. Training may enhance a participant’s ability to reflect on observed events. |
Methods
Theoretical framework: VSR procedures
Literature search
Consultation | Primary care | Video | Qualitative research |
---|---|---|---|
Consultation | Primary health care | Video | Qualitative |
Communication | Family medicine | Film | Experience |
Doctor (or physician, clinician) patient relationship (or talk or rapport or relations) | Family practice | Recording | Attitudes |
General practice | Videodisc | Findings | |
GP | Videotape | Interviews | |
Family physicians | Digital recording | Theme | |
Family doctor | Account |
Inclusion criteria | Exclusion criteria |
---|---|
Studies in primary care | Hospital-based studies, including outpatient clinics |
Observational studies of “real life” GP-patient consultations | Papers written in languages other than English |
Studies that have used video to record the consultation | Video-recorded consultations not shown to research participants |
Studies that have showed the video-recorded consultation to research participants as part of further data collection | Educational research studies concerned with making assessment of doctor or trainee performance |
Describes research question and results, not just methodology | Consultation with other healthcare practitioner (e.g. nurse, physiotherapist) |
Experimental studies or trials | |
Studies involving children | |
Studies using actors or standardised patients |
Quality assessment
1. | Was the research design appropriate to address the aims of the research? |
2. | Was the recruitment strategy appropriate to the aims of the research? |
3. | Were the data collected in a way that addressed the research issue? [This was adapted to 2 sub questions ‘was the data collection clearly described’ (as without this it is not possible to answer whether data collection is appropriate or not) and ‘was the data collected in an appropriate way to address the research question?’] |
4. | Has the relationship between researcher and participants been adequately considered? |
5. | Have ethical issues been taken into consideration? |
6. | Was the data analysis sufficiently rigorous? This includes whether the analysis process is clearly described |
7. | Is there a clear statement of findings? |
8. | How valuable is the research? |
Data extraction
1. | What is the research question? |
2. | How were consultations selected? |
3. | Who were the population of interest? |
4. | How many consultations were videotaped? How many were analysed? |
5. | What methods have been used for analysis of the consultation? |
6. | Has the visual data been analysed? |
7. | Who was subsequently shown the videotapes? (patient or GP) |
8. | How many interviews were conducted? |
9. | How were the videotapes in the interviews selected? |
10. | What format did the interview take? (i.e. how the video playback was incorporated in the interview) |
11. | What was the analysis method of the interviews? |
12. | Has the researcher commented on the acceptability of the research method to participants? |
13. | To what extent did each element of data collection contribute to the findings? |
14. | What are the main findings? |
15. | What are the authors’ main conclusions? |
16. | What are the reviewer’s main conclusions? |
17. | Did each component (interview vs video) contribute to the findings? |
18. | To what extent did the VSR interview add to the research findings? |
Synthesis
Results and discussion
Identification of studies
Reason for exclusion | Number excluded from abstracts | Number excluded from full text |
---|---|---|
Setting: not primary care | 14 | 0 |
Participants: GPs not included | 15 | 0 |
Method: did not include video recorded consultations | 198 | 9 |
Method: Consultations not ‘real life’ | 42 | 1 |
Method: video not shown to research participants | 133 | 12 |
Described method only, no research questions or results | 0 | 1 |
Full text unavailable | N/A | 2 |
Total | 402 | 25 |
Description of included studies
First author and year | Research question | Population/consultations of interest | Area of research |
---|---|---|---|
Ali [20] | To provide a detailed understanding of the ways in which white and South Asian patients communicate with white GPs and to explore any similarities and differences in communication | South Asian patients | Communication: cross cultural |
Als [21] | To identify patterns of GP and patient behaviour related to computer and to identify patient and doctor perceptions of the computer | Unselected | Doctor patient relationship: Impact of computer |
To describe and evaluate a stimulated recall methodology | Unselected (but stratified with respect to age & gender) | Evaluation of VSR method | |
To study the difficulties and dilemmas a GP faces during daily consultations | ‘Difficult’ consultations | ||
To understand phenomena in consultations where the GP has expressed difficulties | Doctor patient relationship | ||
To compare the patients' and the doctors' comments on video-recorded consultations in order to increase understanding of shortcomings in patient-doctor relationship | |||
To describe and understand the experiences of general practitioners in consultations | |||
To describe and understand patients' positive and negative experiences of General Practitioners | |||
To describe the specific behaviour in consultations where the patient experiences a satisfying human relationship with the GP | |||
To characterize health counselling discussion in the consultation | Subsample where health promotion discussed | Health promotion advice | |
To explore self-management support in primary care consultations | Patients with long term conditions | Self-management | |
To explore the relevance of computer information systems in self-management dialogue | Impact of computer | ||
Bugge [19] | To investigate incidences, consequences and reasons for non-disclosure of information in decision making | Consultations in family planning clinic and diabetes clinica
| Decision making |
Cegala [30] | To compare doctor and patient views on communication during the consultation | New and follow up patients | Doctor-patient relationship |
Coleman [14] | To elicit, relate and interpret GP accounts of why they discuss smoking with some patients and not others | Patients who smoke | Decision making |
Cromarty [31] | To describe the range and type of thoughts patients have during their consultations | Unselected | Patients experiences |
Epstein [15] | To describe the structure of HIV related discussion, characterise effective and efficient communication and identify common difficulties | Consultations where HIV risk is discussed | Communication |
Doctor-patient relationship | |||
Difficult consultations | |||
Frankel [32] | To understand the characteristics of the ‘optimal healing environment’ in the consultation | Established patients presenting to doctors with a range of satisfaction scores | Doctor- patient relationship |
Gao [33] | To explore the influence of cultural practices on discussion of colorectal screening | Patients having colorectal screening recommendations | Communication: Cross cultural |
Henry [18] | To understand the impact of tacit clues on making judgements in the consultation | Patients undergoing health maintenance examinations | Decision making |
To understand what occurs in a triadic encounter | Triadic Consultations involving an interpreter | Communication | |
To delineate differences in encounters between professional and family interpreters | |||
Rosenburg [13] | To explore the communication patterns and perceptions between family doctors and psychologically distressed immigrant patients? | Immigrant patients with psychological problems | Communication: Cross cultural |
Saba [36] | To examine shared decision making and the experience of partnership of the doctors and patients | Stratified sample of patients presenting with diabetes or hypertension | Shared decision making |
Timpka [37] | To compare the experiences of patients and care givers of consulting across the primary care team | Patients who encountered more than one team member in a visit | Clinician-patient relationship and team working |
Treichler [38] | To identify and explore the power relations in a triadic consultation with GP, patients and medical student | Traidic consultation with medical student | Doctor-patient relationship |
To explore how electronic health record affects encounters between physicians and patients | Unselected | Doctor-patient relationship: impact of computer |
General methodological considerations
First author and year | Sampling and consent | Effect of video or study methods on behaviour | Other methodological issues identified from QA using CASP tool |
---|---|---|---|
Ali [20] | No mention. | States GPs were recorded over a period of time to try and reduce effect | Mentions inclusion criteria but doesn’t describe these. Not clear in interview if interpreter was used or not, and what questions the patient was asked. Analysis not clearly described. Conclusions appear to be derived from literature review rather than empirical findings. |
Characteristics of consenters described in unreferenced related paper only | |||
Als [21] | States attempted to recruit a sample of variation, characteristics and consent not described | No mention | Analysis not described in detail. |
Characteristics of consenting patients described but not non-consenters. | Mentions in 2 papers the influence of the camera was minimal (self-report from participants) | ||
Characteristics of consenting patients and GPs described but not non-consenters. | No mention | Data collection, rationale for study and analysis described in detail. Possible limited conclusions to be drawn from the study of one consultation when studying self-management support which may happen longitudinally in the doctor patient relationship. | |
Only empirical quotes from nurses reported in 2nd paper, yet conclusions refer to doctors and nurses. In 2nd paper, no discussion about how context of nurse or doctor consultation would influence findings in relation to QOF. | |||
Bugge [19] | Characteristics of consenting patients described but not non-consenters. Limited characteristics of GPs described | Brief mention as limitation | Relative contribution of different post consultation interviews not described (3 per participant). |
Analysis well described. | |||
Cegala [30] | Characteristics of consenting patients and GPs described but not non-consenters. | No mention. Effect on behaviour may be more likely as consultation taken out of normal surgery context and separate microphone on table. | Paper based on assumption that participant’s spontaneous comments during playback (with no guided prompts) can be used to draw conclusions about patient perceptions of doctor competence in communication exchange. |
No information about sampling. | No empirical quotes to support findings. | ||
Coleman [14] | Characteristics of consenters and non-consenters presented. GPs sampled to represent a range of attitudes to smoking | Discussed as potential limitation. | Quantitative methods to support sampling helped gain a maximum variation sample. |
Analysis well described. | |||
Author’s role as GP and peer to GP participant’s not explored. | |||
Cromarty [31] | No mention of details of video selection or recruitment (videos selected by participating GPs and not researcher) | No mention | Relative contribution of different phases of post consultation interview not described (unprompted, with video recall and then written transcript). |
Analysis not described in depth. | |||
Epstein [15] | Characteristics of consenting patients and GPs described but not non-consenters. | One comment that GPs stated not affected. | Robust analysis strengthened by different approaches including coding of behaviours, attention to conversation flow and classification scheme of the level and depth of discussion of HIV risk. |
Discussion of how GPs volunteering to be video recorded may not be representative of GP population. | More than one consultation per GP facilitated robust analysis. | ||
Purposive sampling used to identify patients/ consultations more likely to contain discussion of HIV risk | Not clear how video shown or VSR procedure. | ||
Frankel [32] | No mention | No mention | Research question or theoretical framework lacking. |
Sample size unclear | Participant comments (GP or patient) on video not confidential and revealed to other participant. Consent not mentioned. | ||
Gao [33] | Characteristics of consenting patients described but not non-consenters. Limited characteristics of GPs described | No mention | Recruitment strategy not entirely appropriate: GP interviews not needed to answer research question and weren’t utilised. |
Three stage analysis clearly described. | |||
Henry [18] | Variation sampling of patients to gain mix of gender, age and race. GPs sampled with respect to years in practice and specialty | No mention | Insufficient detail about structure of interview or VSR procedure to judge how appropriate study method was for exploring tacit clues. |
No discussion of how context of health maintenance consultations might influence findings. | |||
Characteristics of sample described (patients and interpreters), but not non-consenters | No mention | Conclusion not supported by results and patient views would have added value and been relevant to research question [34]. | |
Little information about VSR procedure of format of interview [35]. | |||
Rosenburg [13] | Recruitment well described. Characteristics of sample described, but unclear how many underwent VSR | No mention | Method successful in identifying consultations of interest and evidence supports authors’ conclusions. No discussions of limitations. |
Patients made few comments over video and structure of interview not clear. | |||
Saba [36] | Characteristics of sample described but low consent rate not discussed. | Brief mention of possible effect | Robust analysis strengthened by different approaches including analysis within and across cases, contrasting observed and subjective experiences of shared decision making to construct typology of SFM archetypes and using themes from interviews. |
Timpka [37] | Characteristics of consenting patients described but not non-consenters. | Brief mention of possible effect | Complex study but not clear how much video the participants viewed, the instructions the participants were given when watching the video or the consent arrangements. |
Conclusion not supported by results. | |||
Treichler [38] | Case study of one patient. No mention of sampling. | No mention | Limitations associated with the study of one consultation. |
Not described | Brief mention | Analysis well described but no empirical quotes to support findings. More description of consultation context would have increased credibility of findings. |
Acceptability to participants
VSR Procedure: relationship to research question and study quality
Ref | Area of research | Sample sizea
| Interval between consultation and interview | Nature of stimulus | Initiation of recall | Procedural structure | Data used in analysis |
---|---|---|---|---|---|---|---|
Participant (P) | |||||||
Researcher (R) | |||||||
[19] | Decision making | 26(26)C | Not stated | Selected clips only | P (clips by researcher) | ‘Think aloud’ technique | Pre-consultation interview |
9GP | Transcripts from previous interview | Individual topic guides for interviews ‘designed to promote reflection’ | Consultations | ||||
9Ptb
| Immediate post consultation interview | ||||||
VSR interview GP | |||||||
VSR interview Pt | |||||||
[14] | Decision making | 162(86)C | Immediately post | More than one video consultation | Video not stopped | Video shown first, semi structured interview following. Consultations selected for VSR chosen to reflect different discussions regarding smoking | VSR Interview GP |
39GP | (consultations analysed in other paper) | ||||||
[18] | Decision making | 72C | ‘shortly after’ | Video | P and R | Asked to stop video whenever wanted to comment generally or about preventative service plus semi structured interview | Pt VSR interview |
36Pt | GP VSR interview | ||||||
18GP | |||||||
[36] | Shared decision making | 22(18)C | Within 2 weeks | video | P | P asked to stop when identified thoughts, feelings or behaviours associated with decision-making, followed by semi-structured interview | Pt VSR interview |
10GP | GP VSR interview | ||||||
18Pt | Consultations | ||||||
[21] | Impact of computer on doctor patient relationship | 39(39)C | 1 week | Video | P and R | Interview guided by video analysis | Consultations |
12Pt | Pt VSR interview | ||||||
5GP | GP VSR interview | ||||||
Impact of computer on doctor patient relationship | 29C | Not stated | Video | Not stopped | Separate interview and video viewing. GP completed questionnaire when viewing the video | GP post consultation interviews | |
6GP | GP questionnaire completed when watching video | ||||||
Consultation | |||||||
Observations at 4 sites [39] | |||||||
Pt interviews | |||||||
Describe self-management interactions | 86(40)C | 1 week | video | P and R | Semi structured interview and prompts during playback | Patient post consultation interviews | |
Impact of computer | 11GP | 6 VSR interviews (Nurses) | |||||
Consultations (CA [16]) | |||||||
GP VSR interview | |||||||
Evaluation of SR method [22] | 46C | About 1 week | Video, shown more than once | P | No interview. P asked to say what thinking. Neutral prompts if no response. | ||
46Pt | GP asked to comment if unsure how to proceed | ||||||
12GP | Pt and GP questionnaire post viewing (effect of video on behaviour and satisfaction with consultation) [22] | ||||||
(8C, 5GP, 8Pt) | |||||||
[30] | Doctor patient relationship | 32C | Immediately | Video | P | Asked to say stop when they recalled thought or feeling | Satisfaction questionnaire |
16GP | (post consultation) | ||||||
32 Pt | GP VSR comments | ||||||
Pt VSR comments | |||||||
[32] | Doctor-patient relationship | 30C | Not stated | Video | P | P asked to comment on effective communication, things that were new, significant, unusual or important | Pt VSR comments and GP VSR comments edited in to original consultation tape for analysis |
15GP | |||||||
30Pt | |||||||
[38] | Doctor patient relationship | 1C | Not stated | Video | P | P asked to identify problems and concerns | Consultation |
1GP 1Pt | Medical record | ||||||
Pt VSR comments | |||||||
GP VSR comments | |||||||
[15] | Communication | 78(31)C | Not stated | Video | P and R | P asked to stop if any comment, particularly about HIV. R stopped tape after HIV discussion | Consultation |
Doctor patient relationship | 26Pt | Semi structured interview after viewing | Pt VSR interview | ||||
Difficult consultations | 17GP | GP VSR interview | |||||
Communication | 24C | Not stated | Video | P and R | R stopped for ‘key moments’, when interpreter did anything other than translate. Semi-structured interview | GP VSR interviews [34] | |
24GP | Interpreters VSR interviews [35] | ||||||
22C | |||||||
15 Inter-preters | |||||||
[20] | Cross cultural communication | 25C | As soon as possible | Video | Video not stopped | Structured Interview post viewing | Pt VSR interview |
25P | (consultation analysed in other paper) | ||||||
[33] | Cross cultural communication | U | P immediately | Video | P | Questioned first about recall, then asked to stop tape at any point | Pt VSR interview |
44pts | GP not stated | GP VSR interview | |||||
UGP | Consultations | ||||||
[13] | Cross cultural communication | 24(24)C | Within 2 weeks | Video | P and R | R stopped for ‘key moments’ around cross cultural communication | Pt VSR interview |
12GP | Semi-structured interview | GP VSR interview | |||||
24Pt | |||||||
[31] | Patients covert agenda | 121C | Within 8 days | Video | P | 3 phases: unprompted recall of consultation; asked to comment on any topic during video; then prompted by transcript of consultation | Pt VSR interview |
18Pt | Written transcript of consultation | ||||||
[37] | Clinician-patient relationship and team working | 24Pt | One week | Video | P | Asked to stop tape and comment spontaneously | Pt VSR comments |
3GPc
| GP VSR comments | ||||||
Other team members VSR comments |
Stop the tape when you felt uncertain as how to go on | [28] |
Comment on anything new, unusual or different | [22] |
What do you think when you look at the videotape? | [22] |
Stop the tape when you identify thoughts feelings or behaviours associated with decision making | [36] |
Stop the tape at moments you feel important or where you wish to comment, describe what you were thinking or feeling (Preceded with reminder of study focus - communication and cultural differences) | [13] |
Tell me what was happening | [43] |