104 Chapter 6 Multiple interviewees suggested that SDM improved compliance and patient motivation, leading to potentially more effective treatment. According to them, SDM was associated with increased patient satisfaction, a better feeling about the treatment, and reduced regret. According to the clinicians, patients felt seen, heard, and taken seriously during SDM. The exercise with the adjective list, where interviewees had to indicate which adjectives described their attitude towards SDM best, underlined this positive stance towards SDM. There, the adjective ‘rewarding’ was chosen by eleven out of twenty participants, against none of them choosing the adjective ‘unrewarding’. All these relative advantages, however, were downsized by felt disadvantages. For example, the often-mentioned belief that SDM is ‘time-consuming’; eight participants chose this adjective for SDM. Others, however, described that although it may initially take time, SDM ultimately saves time by fostering patient awareness and understanding, preventing future difficulties or regrets: “At first, I thought: ‘Geez, that takes much time.’ However, one has a satisfied patient who does not come up with many questions afterwards, saving time. So that is also an advantage.” Source: additional interviews, resident #4 Other often chosen adjectives from the ADOPT adjectives list describing SDM as potentially disadvantageous were ‘difficult’ or ‘laborious’, each chosen by three out of twenty participants. Furthermore, although clinicians often felt more appreciation from patients when applying SDM principles, varying levels of interest from colleagues for SDM were described. In intercollegial interactions, negative aspects associated with SDM often received more attention than success stories. Persuasion – Compatibility During our practice observations, we noticed that physicians dedicated considerable attention to providing proper patient information during consultations. Some clinicians extended consultation times to ensure adequate patient education. However, SDM was predominantly observed in follow-up consultations when care was less guideline-driven or clear-cut. Examples highlighted the challenges of balancing shared decision-making and the performance of simple medical actions, particularly in diagnostic procedures. For instance, a biopsy was taken during a routine patient consultation without extensive patient involvement in decision-making. Another compatibility issue arose when a patient’s wishes diverged from the doctor’s belief regarding this patient’s optimal course of action. Then, varying levels of support were observed among clinicians, and instances indicated that the patients’ opinions were not always prioritized. Overall, there were considerable variations between individual physicians regarding how extensively patients’ needs and wishes were addressed.
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