title: Analysis of threats to research validity introduced by audio recording clinic visits: Selection bias, Hawthorne effect, both, or neither?
abstract: OBJECTIVE
  To identify factors associated with participant consent to record visits; to estimate effects of recording on patient-clinician interactions.
  
  
  METHODS
  Secondary analysis of data from a randomized trial studying communication about depression; participants were asked for optional consent to audio record study visits. Multiple logistic regression was used to model likelihood of patient and clinician consent. Multivariable regression and propensity score analyses were used to estimate effects of audio recording on 6 dependent variables: discussion of depressive symptoms, preventive health, and depression diagnosis; depression treatment recommendations; visit length; visit difficulty.
  
  
  RESULTS
  Of 867 visits involving 135 primary care clinicians, 39% were recorded. For clinicians, only working in academic settings (P=0.003) and having worked longer at their current practice (P=0.02) were associated with increased likelihood of consent. For patients, white race (P=0.002) and diabetes (P=0.03) were associated with increased likelihood of consent. Neither multivariable regression nor propensity score analyses revealed any significant effects of recording on the variables examined.
  
  
  CONCLUSIONS
  Few clinician or patient characteristics were significantly associated with consent. Audio recording had no significant effect on any of the 6 dependent variables examined.
  
  
  CONCLUSIONS
  Benefits of recording clinic visits likely outweigh the risks of bias in this setting.
authors.affiliation: Department of Internal Medicine, University of California Davis, Sacramento, USA; Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA. Electronic address: sghenry@ucdavis.edu.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Henry
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA; Department of Family and Community Medicine, University of California Davis, Sacramento, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.affiliation: Department of Public Health Sciences, University of California Davis, Davis, USA.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Iosif
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, USA.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Feldman
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA.
authors.forename: Camille
authors.initials: C
authors.lastname: Cipri
authors.affiliation: Department of Internal Medicine, University of California Davis, Sacramento, USA; Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003142:Communication; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D015203:Reproducibility of Results; D012107:Research Design; D015983:Selection Bias; D012680:Sensitivity and Specificity; D013637:Tape Recording
keywords: Audio recording; Consent; Depression; Hawthorne effect; Primary care; Selection bias
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