ReviewAudio-visual recording of patient–GP consultations for research purposes: A literature review on recruiting rates and strategies
Introduction
A vast body of literature provides information and evidence about the pitfalls, advantages, and effects of recording consultations. Yet, one of the greatest challenges researchers face is the recruitment of patients and physicians to studies that include the recording of consultations. Primary health care settings often provide the first contact a patient has with a doctor and are usually less formal than hospital settings. Therefore, recruitment of patients in primary health care to studies using video or audio recordings of consultations is likely to be determined by different factors than recruitment to studies taking place in acute service settings.
Research governance procedures in the UK concerning the recruitment of participants and access to patient data have recently undergone a series of structural, ethical and procedural changes for research. These include the increasing requirement to seek consent even where there is no patient contact; to have a formal “opt-in” (patients have to explicitly express their consent to be considered research participants) rather than an “opt-out” process (patients are considered participants unless they actively contact researchers and demand not to be); and an increasing demand on health researchers in the UK to recruit participants directly rather than through a clinical intermediary. Arguably, this development has led to increased protection of research participants’ safety and wellbeing. Yet, they have also increased the difficulty of conducting rigorous and sound research [1], [2], affected timelines, budgets and the generalisability of research outcomes [3]. These changes mean that response rates have increasing potential for bias [4], [5].
The identification of effective strategies to maximise participation in both experimental and observational research has received considerable attention [6], [7]. The current evidence base shows considerable variation with regard to the effectiveness of recruitment strategies in primary health care [8]. This variation renders it difficult to draw conclusions for specific types of studies, including research involving the recording of patient–physician consultations. This is due to the particular issues and concerns that have been associated with audio and audio/video recording patients and health professionals [9].
The aim of this review is to take stock and present an overview of existing evidence on (a) the ethical issues surrounding the recording of consultations; (b) aspects influencing recruitment rates for patient and GPs; and (c) the effects of recording on the behaviour, attitudes and feelings of patients and GPs in primary health care.
Section snippets
Methods
A structured rather than a fully systematic review of the literature was conducted for the following reasons. The objectives of the review demanded the inclusion of a diverse area of studies. It was not possible to systematically identify studies using audio recordings as this feature of the data collection process is often not indexed as a keyword or mentioned in the abstracts. It had also not been possible to define all the search terms, inclusion and exclusion criteria prior to the review.
Ethical issues surrounding the recording of consultations
A range of papers included a discussion of ethical issues associated with recording patient consultations [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]. The process of obtaining consent was scrutinised and criticised in the literature. It was agreed that the consent process for recording consultations for research purposes should meet the requirement for ethical conduct for any research [23], [24]. However, Block et al. [12] have argued that even if a researcher
Discussion
Exploring GP-patient consultations provides an essential portal to developing the quality of service delivery, patient satisfaction [29], [48], [121], [122], and identifying outcomes of care [14], [123]. A considerable effort has so far been invested in explaining various aspects of doctor–patient interactions [124]. This has been aided by the development of relatively simple, cheap and unobtrusive audio and audio-visual technologies to capture such consultations [14]. Nevertheless, a better
Conclusion
Audio and video-recording consultations for research purposes is a tried and tested means of obtaining rich data on one of the most important aspects of health care provision. This review has shown that from an ethical and practical point of view recording consultations is generally acceptable to both patients and GPs. Scores of research projects showed that recruiting patients and GPs to studies involving audio or video recording is feasible and they provided information on more and less
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