123 General discussion high-quality care by addressing SDM more effectively. It even allows to measure SDM, as it is now translated into recognizable components, adding to its appeal. However, whether these measurements will correlate to high-quality care as proposed in the ‘good work’ movement is questionable. Moreover, the reductionist approach might inadvertently even diminish healthcare quality in the long run, [34] as exemplified in the following section. For instance, decision aids, while designed to provide patient information more easily, often overwhelm patients with data, providing insufficient context for decision-making within their unique situations. [45] When used as a substitute for the clinician engaging with patients to customize pros and cons based on the individual’s specific circumstances, the final decision may even be worse than if the decision aid were not used at all. After all, the information in these aids typically relies on ‘typical’ patients, focusing on disease characteristics rather than the unique context of the individual patient. [45] In such scenarios, the decision is delegated to patients rather than being a collaborative effort. A more appropriate approach would involve healthcare professionals dedicating their expertise and thoughtful consideration to crafting personalized care plans tailored to each patient’s unique context and circumstances based on a built relationship with the patient. This approach embodies the genuine ethical imperative of SDM as a virtue in the pursuit of ‘doing good’ rather than the reductionist approach of simply handing out a decision aid instead. It is crucial to recognize that these ideas touch on specific elements, though not all, of both work ethics and SDM. Additionally, pursuing high-quality SDM is about something other than adopting another alternative model or technique. Our preceding discussion aims to merely underscore the limitations of a simplistic, reductionist approach to SDM. Even an improved approach towards SDM is not immune to the risk of similar inappropriate reductionism, and it may encounter challenges in integration into clinical practice comparable to previous attempts. A thoughtful and well-considered implementation strategy will be essential to navigate future challenges. Therefore, one should learn as much as possible from previous SDM implementation efforts. The following paragraph addresses this topic by scrutinizing SDM as a ‘brilliant failure’, aiming to extract valuable insights that could be instrumental in its continuous evolution and application. SDM a ‘brilliant failure’? Considering the abovementioned aspects, one might question whether SDM could be characterized as a ‘brilliant failure’, a concept initially proposed by Paul Louis Iske. [46] To address this issue, we need to examine the brilliance of SDM as a concept and assess whether its implementation has indeed failed. To begin our evaluation, let us first focus on the latter. Regarding the implementation of SDM, we firmly believe that it has indeed failed. Our thesis consistently reinforces this perspective, and we have identified several factors contributing to this implementation failure, including elements from physician culture and individual determinants for behavior change. One noteworthy additional contributing factor we have 7
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