title: Is there evidence for a better health care for cancer patients after a second opinion? A systematic review.
abstract: BACKGROUND
  With growing complexity of diagnostics and therapy, as well as increasing involvement of patients in the decision-making process, there is more and more demand for second opinions in oncology. This literature review aims at analyzing the benefits and risks involved, as well as the tools needed to establish a structured program for second opinion within a modern healthcare system.
  
  
  METHODS
  A systematic literature search was performed using MEDLINE and Embase and the databases SocINDEX, ERIC and CINAHL. Thirteen articles met the inclusion criteria and offered a relevant insight into the topic of second opinions.
  
  
  RESULTS
  Depending on the study, between 6.5 and 36 % of patients search for a second opinion, due to a variety of reasons. Changes in diagnosis, treatment recommendations or prognosis as a result of the second opinion occurred in 12-69 % of cases. In 43-82 % of cases, the original diagnosis or treatment was verified. Patient satisfaction was high, and the second opinion was deemed as helpful and reassuring in most cases. Yet, data on patient-relevant outcomes or on the quality of the second opinion are missing.
  
  
  CONCLUSIONS
  In general, outcome data on second opinion are divergent and scarce. Yet, with patients' demand for second opinion and influence of second opinion on treatment decisions, a structured, high quality and transparent second-opinion program seems mandatory. Such a program may support patient-physician communication and improve the flow of information, as well as decision-making. Its evaluation should be independent from the provider of the second opinion.
authors.affiliation: German Cancer Society, Berlin, Germany.
authors.forename: Dana
authors.initials: D
authors.lastname: Ruetters
authors.affiliation: German Cancer Society, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Keinki
authors.affiliation: German Cancer Society, Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schroth
authors.affiliation: German Cancer Society, Berlin, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Liebl
authors.affiliation: Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. huebner@med.uni-frankfurt.de.
authors.forename: Jutta
authors.initials: J
authors.lastname: Huebner
mesh_terms: D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D012017:Referral and Consultation
keywords: Cancer; Counseling; Information; Patients’ needs; Second opinion