106 Chapter 6 “When I did that [SDM] with that patient, I felt very good about it. I thought, ‘Wow, I had a good conversation with that lady. (…) We weighed everything from both sides. [We made] a good decision’. However, I had to discuss it with the obstetrician for another half hour, who ultimately could not proceed. (…) That is almost bizarre that you get so much resistance.” Source: additional interviews, resident #10 Persuasion – Trialability In the focused interviews, we found that while some participants (nine out of 20) did not actively or consciously experiment with SDM or faced challenges, many felt they had the freedom to explore different approaches and techniques. However, the opportunity to experiment was influenced by factors such as their level of training or experience, which supervisor was involved, or the specific cases they encountered: “In more complex cases, the supervisor usually leads discussions. So, I have not had much experience with those academic care problems yet. I think I have not had the opportunity to start experimenting [with that] on my own. However, depending on the supervisor, I might get the chance if I ask for it.” Source: additional interviews, resident #3 A few participants mentioned a lack of knowledge and guidance on effective experimentation as barriers to exploring SDM. Time pressure was also identified as a significant limitation to experimenting with SDM. Persuasion – Observability Our observations showed a general lack of discussion about SDM in teaching moments, handover discussions, and tumor board meetings. Furthermore, it was only sporadically observed in other meetings. Most participants mentioned discussing SDM with their colleagues sometimes. These discussions tended to focus more on the medical aspect and patient perspective rather than specific conversation techniques related to SDM: “For example, if you have a difficult case or difficulty deciding with a patient, I sometimes talk about that with colleagues. We then discuss what I found particularly difficult in reaching a decision (...). However, we also discuss medical content, like ‘What would you do in this situation? Would you give these drugs or something else?’” Source: additional interviews, junior doctor #1 Ten out of twenty interviewed physicians did not observe the use of SDM by their colleagues, mainly because it occurred during individual patient consultations without colleagues being present. Some participants had suspicions about its application or the lack thereof.
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