101 Applying a DOI theory-based framework Phase 5 – Interpretation Data interpretation occurred throughout all phases of the research process, as is common in qualitative research. This approach ensured a comprehensive depth of understanding. After all data were collected, the final interpretation was conducted by the broader research team (LS, JA, DB, FS), contributing diverse perspectives and enriching the overall insights drawn from the study. Research team and reflexivity All authors bring experience from their work within a gynecology department, potentially introducing bias into their work. However, one study upon which researchers rely was conducted in partnership with external anthropologists. [19] Additionally, the interviewers and coders in this study had yet to acquire clinical experience. LS is a trained medical educationalist who was an obstetrics and gynecology resident during data collection. JA is a gynecological oncologist with expertise in qualitative research and extensive experience conducting research focused on person-centered care. She has worked both domestically and internationally, thereby cultivating a deep understanding of various healthcare systems and the complexities associated with their implementation. DB is a retired gynecologist and a Professor in Reproductive Medicine. FS is a gynecologist and a Professor in Health Systems Innovation and Education. Results Results are presented in alignment with the (sub-)themes from our DOI-based framework. Prior conditions – Previous practice Drawing primarily from data from the two previous studies, which reflect traditional practices best, it was observed that medical evidence from clinical trials played and still plays a significant role in clinicians’ daily practice. Patient perspectives were not consistently prioritized in meetings or initial treatment decisions. The training of medical professionals emphasized medical knowledge and guidelines rather than coaching on handling patient preferences. In situations with limited medical evidence, clinicians strived to reach a consensus within the team before discussing treatment options with patients. While clinicians often assumed they knew what was best for their patients, they also demonstrated dedication to patient well-being, actively seeking to understand their needs and providing comprehensive support. Prior conditions – Felt needs Accurately identifying genuine felt needs for using SDM posed a challenge, as felt needs are less apparent in interviews and observational data. However, indications of an intrinsic desire to involve patients in their care pathways were observed. An example is the patients’ presence and active participation during morbidity and mortality meetings at the department, [26] which is not common in the Dutch healthcare system. 6
RkJQdWJsaXNoZXIy MTk4NDMw