102 Chapter 6 In interviews, physicians demonstrated a strong awareness of patients’ wishes and preferences, highlighting the necessity for tailored decision-making. Explicitly mentioned reasons supporting the need for SDM included patient autonomy, adherence to good medical practice, the perception of SDM as the gold standard, and the belief that SDM is the optimal approach in medical decisionmaking. The explicit incorporation of SDM into patient consultations, such as through decision aids and other SDM-supporting materials, through initiation by patients, or promoted by clinicians or their supervisors, increased the perceived need for SDM. One resident made a concrete suggestion on how to foster SDM integration into group meetings dedicated to discussing patient cases: “I think one sentence should be used: ‘The patient prefers…’ That says enough, and one can carry that with oneself.” Source: additional interviews, resident #2 However, there were also instances when a limited need for SDM was expressed. Most clinicians believed that SDM should primarily be employed when multiple comparable treatment options are available or when choices are unclear while still ensuring safety boundaries: “I think it is important that you stay within medically safe options. However, if there are comparable options: yes. And the patient has a choice: Yes, it is necessary. They must deal with the result, not us.” Source: additional interviews, gynecologist #7 Prior conditions – Innovativeness The level of innovativeness was hard to establish from the data as well. However, based on a few SDM-related initiatives initiated and visible within the department during data collection, an innovative nature was suggested. For example, the gynecological oncology department was in the middle of a research project designing cancer-specific decision aids, [27] and initiated the previously mentioned patient participation at morbidity and mortality meetings. [26] In general, we observed many interactions concerning discussing new (scientific) insights and the application of up-to-date scientific knowledge. Prior conditions – Norms of the social system As in any social system, cultural and language differences between clinicians and patients influence decision-making. Direct communication was common in the department under study, and gynecologists were typically approachable, involved, and open to new insights. Empathy and involvement were prominent traits among gynecologists towards both patients and colleagues. However, a hierarchical structure was still observed within team meetings, with gynecologists generally holding decision-making power over others. Nurses were present in meetings but usually did not actively participate in discussions or treatment decision-making. Clinicians generally valued the well-being and opinions of patients. However, some prioritized their own opinions over patients’ wishes, e.g., prioritizing survival chances over the quality of life during decision-making. We also observed that dealing with uncertainty was a concern for clinicians, and uncertainties were more frequently discussed among physicians than with patients.
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