107 Applying a DOI theory-based framework Discussion The adoption or rejection of Shared Decision Making (SDM) is a complex process that involves reflecting upon its benefits while recognizing the existing limitations and challenges. The application of Rogers’ framework has facilitated the investigation of this complex process. Our study demonstrates that clinicians acknowledged the need to utilize SDM, which upholds patient autonomy and adheres to good medical practice. They perceived SDM as a potentially valuable approach to medical decision-making. Decision aids provided specific advantages, benefiting clinicians and patients in making treatment decisions and promoting the adoption of SDM. However, clinicians also recognized the limitations and challenges associated with SDM. Disadvantages found are the conviction SDM is time-consuming, difficult, or laborious. Compatibility issues arose when patients’ wishes differed from clinicians’ views, or no equivalent treatment options were available. Also, the pace of healthcare practice did not always allow for SDM to happen. The perceived complexity of SDM varied depending on the situation and aligned with compatibility issues. Colleagues also added to SDM’s perceived complexity, as clinicians in our study felt they had to justify their decisions towards them, and appreciation for good SDM practice was lacking. Clinicians did not recognize the trialability of SDM, and SDM was sparsely observed, both in meetings and doctor-patient encounters. Multiple theories have been applied to capture factors influencing SDM implementation, including Normalization Process Theory (NPT). [28, 29] NPT, for example, often has been used for evaluations of innovation implementation. However, NPT highlights innovation benefits rather than delving into reasons for rejection. [30] In our perspective, recognizing and understanding the adverse influences impacting SDM adoption – such as the negative perceived characteristics in our study – is pivotal for establishing a foundation to drive innovation. Therefore, NPT was deemed less beneficial for the development of our framework. Moreover, current change practices and evaluation theories such as NPT tend to overlook complexities associated with behavioral change, often adopting a reductionist approach when addressing barriers to SDM. This reductionist approach simplifies the determinants of change by treating them as measurable independent variables, assuming that addressing these variables successfully will automatically result in a shift in practice. [31] However, this linear and causal perspective fails to encompass the complete intricacy of SDM adoption. Our study introduces a novel framework for evaluation based on DOI theory, aiming to comprehend better why clinicians fail to adopt SDM. The next logical step would involve better facilitation of behavioral change. To gain a deeper understanding of the process of behavioral change, Cognitive Dissonance Theory, initially proposed by Festinger in 1957, offers valuable insights. [32] This theory explains the psychological discomfort individuals experience when they hold conflicting beliefs or attitudes. [32, 33] In the context of SDM, clinicians who recognize the importance of patient involvement may experience cognitive dissonance when confronted with their current practices, 6
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