Second opinion programmes in Germany: a mixed-methods study protocol

Abstract

IntroductionSecond opinion programmes aim to support the patients’ decision-making process and to avoid treatments that are unnecessary from a medical perspective. The German second opinion directive, introduced in December 2018, constitutes a new legal framework in statutory health insurance for seeking second opinions for elective procedures and so far includes tonsillectomy, tonsillotomy, hysterectomy and shoulder arthroscopy. The directive mandates physicians who recommend one of the above-mentioned surgeries to inform their patients of their legal right to visit a certified second opinion provider. Since second opinion programmes are a fairly recent phenomenon in Germany, no comprehensive data are yet available on the degree of implementation, users, potential barriers and their effectiveness. We aim to examine the characteristics and the use of second opinion programmes as well as the needs and wishes from the perspective of (potential) users in Germany, with focus on the decision-making process, the patient–physician relationship and the motivation to seek a second opinion, as well as the role of health literacy.Methods and analysisSix substudies will include the following stakeholders: (1 and 2) patients with one of the four surgery-indications covered by the directive, (3) patients who electively sought an online-based second opinion, (4) patients with oncological diseases, (5) the general population and (6) medical specialists. A mixed-methods approach will be used, including questionnaires, interviews and focus groups. The data will be evaluated using quantitative descriptive analysis and qualitative content analysis. The integration of the results will take place in the form of a triangulation protocol.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Brandenburg Medical School. The findings will be published in peer-reviewed journals and presented at scientific conferences.

Physicians’ Perspectives on the Implementation of the Second Opinion Directive in Germany—An Exploratory Sequential Mixed-Methods Study

“…This study is part of the ZWEIT-project [ 10 ], which examines the characteristics and the use of Second Opinion programs in Germany, as well as the needs and wishes from the perspectives of physicians and their patients, the potential service users. This study was supported by the Innovation Committee at the Federal Joint Committee (Innovation Fund, grant number 01VSF18014).…”

The impact of the COVID-19 pandemic on professional practice and patient volume in medical practices: A survey among German physicians and psychotherapists

“…We developed and piloted a questionnaire instrument to assess potential impact of the COVID-19 pandemic on patient volume, emotional and financial burden, job changes, health care system changes, as well as professionals' attitudes towards their work during the pandemic, information need, availability of information and Please cite this article in press as: Bruch D, et al The items were developed in a first version by the researchers based on the research question. Some of the potential challenges in outpatient care were known from the ZWEIT project [14], in which the researchers cooperate closely with practising physicians. Then, the questionnaire was discussed and piloted with two physicians affiliated with outpatient practices.…”

Attitude toward second opinions in Germany – a survey of the general population

“…The survey was conducted as part of the ‘ZWEIT’ project funded by the ‘Innovation Fund’ of the Federal Joint Committee. More details on ZWEIT can be found in the study protocol [ 18 ]. Our survey was approved by the ethics committee of Witten/Herdecke University (case number: 162/2019).…”