Background Second medical opinions can give patients confidence when choosing among treatment options and help them understand their diagnosis. Health insurers in several countries, including Germany, offer formal second opinion programs (SecOPs). We systematically collected and analyzed information on German health insurers’ approach to SecOPs, how the SecOPs are structured, and to what extent they are evaluated. Methods In April 2019, we sent a questionnaire by post to all German statutory (n = 109) and private health insurers (n = 52). In September 2019, we contacted the nonresponders by email. The results were analyzed descriptively. They are presented overall and grouped by type of insurance (statutory/private health insurer). Results Thirty one of One hundred sixty one health insurers (response rate 19%) agreed to participate. The participating insurers covered approximately 40% of the statutory and 34% of the private health insured people. A total of 44 SecOPs were identified with a median of 1 SecOP (interquartile range (IQR) 1–2) offered by a health insurer. SecOPs were in place mainly for orthopedic (21/28 insurers with SecOPs; 75%) and oncologic indications (20/28; 71%). Indications were chosen principally based on their potential impact on a patient (22/28; 79%). The key qualification criterion for second opinion providers was their expertise (30/44 SecOPs; 68%). Second opinions were usually provided based on submitted documents only (21/44; 48%) or on direct contact between a patient and a doctor (20/44; 45%). They were delivered after a median of 9 days (IQR 5–15). A median of 31 (IQR 7–85) insured persons per year used SecOPs. Only 12 of 44 SecOPs were confirmed to have conducted a formal evaluation process (27%) or, if not, plan such a process in the future (10/22; 45%). Conclusion Health insurers’ SecOPs focus on orthopedic and oncologic indications and are based on submitted documents or on direct patient-physician contact. The formal evaluation of SecOPs needs to be expanded and the results should be published. This can allow the evaluation of the impact of SecOPs on insured persons’ health status and satisfaction, as well as on the number of interventions performed. Our results should be interpreted with caution due to the low participation rate.

Background Second medical opinions (SOs) can assist patients in making informed treatment decisions and improve the understanding of their diagnosis. In Germany, there are different approaches to obtain a structured SO procedure: SO programs by health insurers and SOs according to the SO Directive. Through a direct survey of the population, we aimed to assess how structured SOs should be provided to fulfil patients’ needs. Methods A stratified sample of 9990 adults (≥18 years) living in the federal states of Berlin and Brandenburg (Germany) were initially contacted by post in April and sent a reminder in May 2020. The survey results were analyzed descriptively. Results Among 1349 participants (response rate 14%), 56% were female and the median age was 58 years (interquartile range (IQR) 44–69). Participants wanted to be informed directly and personally about the possibility of obtaining an SO (89%; 1201/1349). They preferred to be informed by their physician (93%; 1249/1349). A majority of participants would consider it important to obtain an SO for oncological indications (78%; 1049/1349). Only a subset of the participants would seek an SO via their health insurer or via an online portal (43%; 577/1349 and 16%; 221/1349). A personally delivered SO was the preferred route of SO delivery, as 97% (1305/1349) would (tend to) consider this way of obtaining an SO. Participants were asked to imagine having moderate knee pain for years, resulting in a treatment recommendation for knee joint replacement. They were requested to rate potential qualification criteria for a physician providing the SO. The criteria rated to be most important were experience with the recommended diagnosis/treatment (criterion (very) important for 93%; 1257/1349) and knowledge of the current state of research (criterion (very) important for 86%; 1158/1349). Participants were willing to travel 60 min (median; IQR 60–120) and wait 4 weeks (median; IQR 2–4) for their SO in the hypothetical case of knee pain. Conclusion In general, SOs were viewed positively. We found that participants have clear preferences regarding SOs. We propose that these preferences should be taken into account in the future design and development of SO programs.

BackgroundSecond medical opinions (SOs) can strengthen patients’ certainty in decision-making. Since 2019, statutory health insured German residents have the right to obtain an SO for selected indications according to the SO Directive. Additionally, several health insurers offer SO programs often in cooperation with telemedical SO providers. Telemedical SO programs are mostly based on documents only. Our aim was to analyze the characteristics of people who obtained telemedical SOs, their experiences made during the SO process, and their assessment of SOs in general and of the different routes of SO delivery (personally/by phone/documents only).MethodsGerman residents who obtained an SO via an online portal between January 2016 and February 2019 (n=1247) were contacted by post between August and November 2019 up to three times. The results were analyzed descriptively.ResultsThe 368 participants (response rate 30%) were 54% male, 95% statutory health insured and 61 years old (median; interquartile range 51-72). Most participants reported having an orthopedic condition (87%) or had been recommended surgery (78%). The most common reason for seeking an SO in general was the need for more information on further treatment recommendations (64%). A telemedical SO was mainly chosen because it was offered by the health insurer (82%). Disagreements between first opinions and SOs occurred in 55% of the participants. Approximately 60% of the participants with disagreements followed the treatment recommendation of the SO. For 67% of the participants, the SO (rather) enhanced the certainty in decision-making. Approximately 75% were (rather) satisfied with obtaining the SO via the online portal, and 95% would seek another SO (irrespective of the online portal). The most preferred route of SO delivery was a personally delivered SO, which 80% would (rather) consider, followed by 70% (rather) considering SOs based on documents only and 48% (rather) considering SOs by phone.ConclusionSOs were generally appreciated. Although our results show that SOs (based on documents only) support patients and that patient satisfaction was high, personally delivered SOs were still preferred. Future research on the use of SOs based on documents only (in which patient population and in what situations) is needed.

BackgroundSecond medical opinions (SOs) can strengthen patients' certainty in decision-making. Since 2019, statutory health insured German residents have the right to obtain an SO for selected indications according to the SO Directive. Additionally, several health insurers offer SO programs often in cooperation with telemedical SO providers. Telemedical SO programs are mostly based on documents only. Our aim was to analyze the characteristics of people who obtained telemedical SOs, their experiences made during the SO process, and their assessment of SOs in general and of the different routes of SO delivery (personally/by phone/documents only). MethodsGerman residents who obtained an SO via an online portal between January 2016 and February 2019 (n=1247) were contacted by post between August and November 2019 up to three times. The results were analyzed descriptively. ResultsThe 368 participants (response rate 30%) were 54% male, 95% statutory health insured and 61 years old (median; interquartile range 51-72). Most participants reported having an orthopedic condition (87%) or had been recommended surgery (78%). The most common reason for seeking an SO in general was the need for more information on further treatment recommendations (64%). A telemedical SO was mainly chosen because it was offered by the health insurer (82%). Disagreements between rst opinions and SOs occurred in 55% of the participants. Approximately 60% of the participants with disagreements followed the treatment recommendation of the SO. For 67% of the participants, the SO (rather) enhanced the certainty in decisionmaking. Approximately 75% were (rather) satis ed with obtaining the SO via the online portal, and 95% would seek another SO (irrespective of the online portal). The most preferred route of SO delivery was a personally delivered SO, which 80% would (rather) consider, followed by 70% (rather) considering SOs based on documents only and 48% (rather) considering SOs by phone. ConclusionSOs were generally appreciated. Although our results show that SOs (based on documents only) support patients and that patient satisfaction was high, personally delivered SOs were still preferred. Future research on the use of SOs based on documents only (in which patient population and in what situations) is needed.

Objective Participant recruitment is one of the main challenges in research. It is suggested that including researcher photographs might increase participation rates, but empirical evidence is lacking. This study within a trial (SWAT) aims to assess whether invitation letters including researcher photographs increase the participation rate in the context of a survey on medical second opinions. Methods Through 25 local register offices in Berlin and Brandenburg (Germany), we identified a random sample of 9990 persons. We randomly assigned our sample to the intervention group (IG) receiving an invitation letter with researcher photographs and control group (CG) receiving an invitation letter without photographs in a 1:1 ratio. Our primary outcome was the participation rate. Furthermore, we compared participants to non-participants’ characteristics. Results Of 9990 invitations, 9797 could be delivered (IG: 4890, CG: 4907). Of these, 1349 (13.8%) participated. There were 682/4890 (13.9%) participants in the IG and 662/4907 (13.5%) in the CG with an odds ratio of 1.030 (95% confidence interval: 0.918–1.156). Additional analyses on non-participant characteristics did not show any differences. Conclusion We could not find any difference in the participation rates. Our study does not confirm the results of previous studies. The length of our questionnaire may have affected our results. Trial registration Queens University Belfast – SWAT Store, SWAT 104.