Creating and administering video vignettes for a study examining the communication of diagnostic uncertainty

Why it matters

It can be difficult to study clinician-patient communication, especially when researchers are looking at cause-and-effect relationships. One reason for this is that there can be logistical and ethical problems involved in observing sensitive or emotive conversations. Video vignettes, which are an alternative option for researchers, are hypothetical yet realistic scenarios that can be used alongside the more traditional observational approaches. In a vignette, it’s possible to isolate and change an aspect of a communication in a way that can’t be done in real life. Patients might also be unwilling to criticise their own doctor, but happy to do so when they are presented with a hypothetical situation.

There are already guidelines available which outline the stages necessary to create valid video vignette studies, but it can be a challenge to put together high-quality vignettes which are also accessible to a wide range of participants. Time and budget restraints can be an issue too. Until the last decade, there was little evidence-based guidance or practical instruction to help researchers with developing their own video vignettes, and even more recent vignette studies often fail to clearly report the various methodological stages.

This paper outlines the methods we used to create four valid video vignettes used to study the communication of diagnostic uncertainty. It outlines some of the things that researchers who are planning to carry out video vignette studies might want to consider, provides practical recommendations for future researchers, and prompts further refection on accessibility issues in video vignette methodology.

Our approach

We produced four video vignettes that were used in an online study examining the communication of diagnostic uncertainty. We followed established guidelines for vignette production, looking specifically at the ways in which they might be applied practically to save time and resources. We then pilot-tested the scripts with the help of 15 laypeople, and the videos with 14 laypeople. The pilot-testing involved both quantitative and qualitative analysis.

What we found

Our research showed that the existing guidelines for video vignette production were useful, but also demonstrated that vignette production doesn’t have to be expensive or time-consuming to be valid. We filmed our vignettes using an iPhone camera, and they featured an actual physician instead of a professional actor, but even so, the pilot-testing suggested that they are internally and externally valid for experimental use.

We suggest that as long as the initial script development is carefully done, and if the techniques used for filming and pilot testing are practical, it’s very possible for researchers to create valid vignettes in a reasonable time and within budget restraints. We also suggest that further research should consider the potential benefits and unintended consequences of online video vignette methodology, which hasn’t been considered in depth in existing research.

We particularly emphasise two aspects of our methodology: the creation of high-quality vignettes in a cost-effective manner, and the use of an online platform, which we argue are important to making video vignette methodology more accessible – both to researchers, and to diverse patient populations.

We believe that these techniques and methods could helpfully be adapted to be inclusive of those from underserved backgrounds. Researchers who want to create studies using video vignettes can adapt the development process to suit their own time and budget constraints, and in ways which can also make the best use of available technology. It might be that online methods could be useful for increasing participant accessibility, but future research should explore more inclusive vignette design.