125 General discussion Nonetheless, avoiding the assumption that introducing this redefined or revisited version of SDM will automatically guarantee success is crucial. Applying the same lessons drawn from sociology, psychology, and change theory is vitally important to implement this updated approach effectively. Our thesis strongly emphasizes the need for heightened awareness and open discussion about SDM among practitioners. These discussions enable a genuine reevaluation of SDM’s virtues and limitations, fostering a comprehensive understanding of the challenges that may emerge during any implementation process. Subsequently, strategies based on behavior change theories can be applied to overcome these challenges effectively. Implications for practice and future research As SDM is not the sole solution to healthcare decision-making, the recommendations in this section are not the definitive solution to its implementation. They are meant as a guide, a compass, for future SDM practice and research. This thesis presents one particularly significant practical implication: We must embrace SDM’s complexity instead of the prevalent simplistic SDM approach. The essence of being a ‘good doctor’ lies in delivering optimal care to each unique patient. Therefore, clinicians should receive training that equips them to fulfill this role. Furthermore, medical practice should be restructured to promote the embodiment of this virtue rather than relying on misguided incentives like measuring quality indicators that may not truly enhance healthcare quality. Consequently, we should move away from merely creating decision aids and focus on genuinely empowering physicians to understand their patients’ needs. Clinicians’ priority should be tailoring healthcare to individual patient needs and establishing meaningful relationships with their patients. Decision aids can be valuable tools only when used correctly within the proper context. Their role is most effective when integrated into a clinician’s consultation process rather than serving as standalone sources of patient information, as is often the case today. More importantly, we should encourage a cultural shift by fostering open discussions within the community of doctors, explicitly addressing and reflecting on the challenges and drawbacks of SDM. Dissonant cognitions, which can be powerful yet often concealed forces, play a significant role in shaping doctors’ actions. To effectively address these, it is essential to first bring them into the open. To validate our thesis findings, we should expand the scope of our research by conducting more ethnographic and interview studies that explore the medical culture related to SDM in diverse settings. Additionally, it is advisable to perform practice assessments before introducing any innovation. This approach will facilitate the customization of interventions to the unique context in which they will be implemented. Subsequent implementation studies should then evaluate whether this tailored strategy indeed leads to improved outcomes compared to previous implementation attempts. 7
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