The provision of audio recordings of their own medical encounters to patients, termed consultation recordings, can help to address information needs of patients by improving understanding, recall, and feeling informed (van der Meulen et al., 2008; Tsulukidze et al., 2014; Barr et al., 2018; Rieger et al., 2018). High information needs are common among cancer patients (Rutten et al., 2005), especially shortly after diagnosis (Matsuyama et al., 2013). Medical consultations are the most important source of information for cancer patients (Rudolph et al., 2015). Ensuring patients receive comprehensible information is crucial, as emphasized in health policy (Bundestag, 2013). A systematic review found that patients with fulfilled information needs experience better health-related quality of life and less anxiety and depression (Husson et al., 2011). However, patients often struggle to accurately recall information provided during medical encounters, with up to 80 percent being forgotten (Ley, 1979; Kessels, 2003; Jansen et al., 2008; van der Meulen et al., 2008; Watson and Mckinstry, 2009; Sherlock and Brownie, 2014). Various reasons have been proposed, including anxiety, pain (Kessels, 2003; Rimmer, 2019) and cognitive deficits (Kessels, 2003; Janelsins et al., 2014; Pendergrass et al., 2018).

One intervention to address this issue is providing patients with consultation recordings. Several international studies have investigated this intervention, predominantly focusing on cancer patients (Tsulukidze et al., 2014), with the majority of research conducted in the United States (Tsulukidze et al., 2014; Elwyn et al., 2017; Grande et al., 2017; Barr et al., 2018, 2021; Joshi et al., 2020; Kwon et al., 2021; Smith et al., 2022), Australia (Lipson-Smith et al., 2016; Moloczij et al., 2017; Hyatt et al., 2018, 2020; Petric et al., 2021; Ryan et al., 2022), and the United Kingdom (Elwyn et al., 2015; Ivermee and Yentis, 2019; Shepherd et al., 2023). Empirical evidence supporting this intervention reveals a wide range of benefits, which help to meet information needs of patients by improving information recall (van der Meulen et al., 2008; Tsulukidze et al., 2014; Barr et al., 2018; Hyatt et al., 2018; Rieger et al., 2018; Dommershuijsen et al., 2019; Kwon et al., 2021; Petric et al., 2021; Shepherd et al., 2023), increasing feelings of being informed (Dommershuijsen et al., 2019; Hack et al., 2021), and enhancing understanding (van Bruinessen et al., 2017; Barr et al., 2018; Hyatt et al., 2018; Kwon et al., 2021; Shepherd et al., 2023). Further benefits include increased patient empowerment (Elwyn et al., 2015; Grande et al., 2017; Hyatt et al., 2020; Smith et al., 2022), facilitation of discussions with family members (Dommershuijsen et al., 2019; Hyatt et al., 2020; Kwon et al., 2021; Petric et al., 2021), heightened satisfaction with care (Pitkethly et al., 2008; Dommershuijsen et al., 2019), improvement in decision-making (Dommershuijsen et al., 2019; Kwon et al., 2021; Smith et al., 2022), and reductions in anxiety and depression (Tsulukidze et al., 2014; Rieger et al., 2018; Smith et al., 2022). Research has explored various ways of implementing this intervention, including patient-led recordings [i.e., patients asking clinicians to record with their own recording device or cell phone (Ryan et al., 2022)], covert recordings (Elwyn et al., 2015; Barr et al., 2018), or provision of recordings, for example via patient-centered smartphone apps (Hyatt et al., 2020; Barr et al., 2021). Nevertheless, the prevalence of consultation recordings for patients remains relatively low, ranging from 15 [United Kingdom (Elwyn et al., 2015)] to 18 [United States (Barr et al., 2018)] percent of patients reporting to have recorded at least one medical consultation in the past. This might be linked to barriers related to the implementation of consultation recordings. Concerns include the potential escalation of patient anxiety from hearing distressing content (Tsulukidze et al., 2014; Moloczij et al., 2017; Hyatt et al., 2018; Hack et al., 2021), a negative impact on the patient-physician relationship (Tsulukidze et al., 2014; Elwyn et al., 2015; Grande et al., 2017; Moloczij et al., 2017; van Bruinessen et al., 2017; Dommershuijsen et al., 2019), healthcare personnel feeling uneasy about being recorded (Tsulukidze et al., 2014; Moloczij et al., 2017; van Bruinessen et al., 2017; Barr et al., 2018; Ivermee and Yentis, 2019), and worries about medico-legal implications (Tsulukidze et al., 2014; Elwyn et al., 2015; Moloczij et al., 2017; van Bruinessen et al., 2017; Barr et al., 2018; Rieger et al., 2018; Ivermee and Yentis, 2019; Joshi et al., 2020; Ryan et al., 2022). Additionally, concerns were raised that consultation recordings could prolong consultations (Tsulukidze et al., 2014; Moloczij et al., 2017). However, consultation recordings have not been found to substantially extend consultation times (Hack et al., 2013; Tsulukidze et al., 2014; Petric et al., 2021). Furthermore, previous studies suggest that patients who received a consultation recording needed less phone calls and had fewer questions later on (Hack et al., 2013; Tsulukidze et al., 2014; Petric et al., 2021). Nevertheless, patients in general express a positive attitude toward consultation recordings (Barr et al., 2018; Dommershuijsen et al., 2019; Ivermee and Yentis, 2019; Hack et al., 2021; Petric et al., 2021; Smith et al., 2022), and express a desire to record consultations in the future (Elwyn et al., 2015; Barr et al., 2018; Dommershuijsen et al., 2019).

Effective implementation of interventions relies heavily on contextual factors, such as culture (Damschroder et al., 2022). However, there is limited research on consultation recordings in Germany. To assess the intervention’s feasibility in the German healthcare context, this study aimed to assess the attitudes and experiences of cancer patients in Germany toward the provision of audio recordings of medical encounters.

We report on a cross-sectional nationwide quantitative survey exploring cancer patients’ attitudes and experiences regarding consultation recordings in Germany. Reporting follows the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Eysenbach, 2004) (cp. Supplementary file S1).

In this initial exploration of cancer patients’ views on consultation recordings in Germany, we identified predominantly positive attitudes and high level of agreement regarding potential benefits. Concerns related to consultation recordings were also reported, albeit with less emphasis. Participants viewed encounters involving decisions about complex and burdensome treatment regimens as particularly suitable for recording. Older age was associated with less favorable attitudes toward consultation recordings in our sample. While a minority of participants in our sample had prior experiences with consultation recordings, the majority expressed interest in having consultation recordings in the future. Positive attitudes toward consultation recordings seem to be associated with a desire for future use.

In relation to participants’ positive attitudes toward consultation recordings, our findings align with existing research (Barr et al., 2018; Dommershuijsen et al., 2019; Ivermee and Yentis, 2019; Hack et al., 2021; Petric et al., 2021; Smith et al., 2022). Our study also supports previous research indicating that patients value consultation recordings as a suitable solution to the challenge of recalling and comprehending information from medical encounters (van der Meulen et al., 2008; Tsulukidze et al., 2014; van Bruinessen et al., 2017; Barr et al., 2018; Hyatt et al., 2018; Rieger et al., 2018; Dommershuijsen et al., 2019; Kwon et al., 2021; Petric et al., 2021; Shepherd et al., 2023). Consequently, we can conclude that participants would appreciate consultation recordings as a means to address their information needs. Moreover, we found that consultation recordings were expected to be particularly beneficial in contexts involving treatment decisions, which is consistent with prior research demonstrating that consultation recordings are useful for decision-making (Dommershuijsen et al., 2019; Kwon et al., 2021; Smith et al., 2022). It is noteworthy that in our sample, similar to findings from previous research (Barr et al., 2018), older patients seem to be less in favour of consultation recordings. If age is the cause of the more negative attitudes or a proxy for another cause, it needs to be evaluated in subsequent studies. At the same time, both our study and previous research suggest that consultation recordings could be particularly beneficial for older patients (Dommershuijsen et al., 2019). Nevertheless, some participants expressed concerns about consultation recordings, particularly regarding a potential negative shift in the openness of the physician and in the physician-patient-relationship. Those concerns were also found in previous research (Tsulukidze et al., 2014; Elwyn et al., 2015; Grande et al., 2017; Moloczij et al., 2017; van Bruinessen et al., 2017; Dommershuijsen et al., 2019). Nevertheless, it is worth noting that the overall level of concern about these issues was relatively low, suggesting that participants believe the benefits of consultation recordings outweigh potential disadvantages.

Only a small percentage of participants reported having prior experience with consultation recordings (either overt or covert). This highlights that consultation recordings are not yet widely utilized in Germany, consistent with findings from international studies (Elwyn et al., 2015; Barr et al., 2018). Notably, a considerable amount of those who had shared the recording did so with a relative, emphasizing the potential role of consultation recordings for facilitating discussions and information sharing with the patient’s support network. This observation aligns with findings from previous studies (Dommershuijsen et al., 2019; Hyatt et al., 2020; Kwon et al., 2021; Petric et al., 2021). Furthermore, our study revealed that in almost all cases, participants took the initiative to record the medical encounter with their own cell phone, showcasing an accessible approach to this intervention. The majority of participants also expressed a desire to have consultation recordings in the future, with most of them considering recording the encounter with their own cell phone. This underscores the potential of consultation recordings to not only improve patient outcomes such as recall and comprehension of medical information but also to promote patients’ engagement in their own healthcare, consistent with findings from previous research (Elwyn et al., 2015; Grande et al., 2017; Hyatt et al., 2020; Smith et al., 2022).

The overwhelmingly positive attitudes of our sample, coupled with the expressed desire for consultation recordings in the future, underscores its potential for the German healthcare system. However, the limited experiences of our sample suggests that this potential remains largely underutilized in German cancer care. This could be attributable to physicians in Germany being less open toward technological and digital innovations in general and viewing changes in power structure (e.g., empowering patients) as less favorable than in other countries, thus slowing the adoption of technological innovations in Germany (Safi et al., 2018; Hansen et al., 2019). Furthermore, the link between attitudes and desire to use consultation recordings warrants further exploration.

Despite comprehensive international research on consultation recordings and their well-documented benefits and effects, their applicability to the German healthcare system remains uncertain. Future research, including randomized controlled trials, should delve deeper into the effects within this context and consider diverse perspectives, such as those of relatives, health professionals, and healthcare institutions.

A major strength of our study is that it presents the first investigation of consultation recordings in the German healthcare setting, therewith closing a relevant research gap. Additional strengths include the preceding qualitative interviews that informed the development of our quantitative questionnaire. However, our study is not without limitations. First, selection bias, which limits the generalizability and validity of our results, is anticipated, particularly given that our sample was obtained through self-help groups and patient organizations. This suggests a potential bias toward a more favorable disposition toward patient-centered interventions. Additionally, our sample comprised relatively young and female participants with a high level of education. It is also presumed that due to the online recruitment of participants, individuals with lower technological competence might be underrepresented. This might have contributed to a bias toward positive attitudes about consultation recordings, which might have led to over estimating the feasibility of the intervention. Moreover, the majority of our sample consisted of individuals expressing their attitudes toward an intervention with which they lack personal experience. Second, this study focused on descriptive analyses. We therefore did not conduct power analyses, which limits the external validity of our results. Third, data collection occurred during the peak period of the COVID pandemic, when patients were often alone in medical consultations and were possibly more inclined to welcome an “additional pair of ears,” for which consultation recordings could have been used. Additional limitations include the lack of investigation into reasons for non-participation and the absence of a standardized and psychometrically sound questionnaire to assess attitudes toward consultation recordings.

In conclusion, this study represents an initial exploration of the intervention’s potential within the German cancer care context, laying the groundwork for its further evaluation.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

This study involving humans were approved by the Psychological Ethics Committee of the Center for Psychosocial Medicine of the University Medical Center Hamburg-Eppendorf. This study were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

CT: Investigation, Writing – original draft, Formal analysis. IS: Writing – review & editing, Supervision, Project administration, Methodology, Funding acquisition, Conceptualization. PH: Writing – review & editing, Supervision, Project administration, Methodology, Formal analysis, Conceptualization, Funding acquisition.