135 Summary enhance the effectiveness of SDM interventions. The framework proposed in this chapter could serve as a robust foundation for future evaluation frameworks in this context. Chapter 3 outlines the objectives and results of a pilot study focused on assessing the impact of patient feedback on residents’ skills in SDM and general consultation. The study involved eleven residents in Obstetrics and Gynecology, and after consultations, patients were asked to provide feedback using a six-item questionnaire, including validated tools like ‘CollaboRATE’ for SDM assessment. Quantitative analysis of questionnaire results reveals no significant differences in residents’ scores over time. Residents were interviewed, and thematic analysis using a reflexivity framework was applied to their responses. Findings show that residents are able to reflect on their SDM skills but struggle to derive substantial learning points from the feedback. Although immediate skills improvement was not apparent, the study highlights the potential benefits of patient feedback. To enhance behavior change, the study suggests combining patient feedback with facilitated reflections at appropriate intervals and emphasizes the vital role of supervisors in facilitating these reflective processes. Chapter 4 investigates the influence of physician culture on SDM practice. Through a tenweek hospital ethnography in a gynecological oncology department in the Netherlands, both an insider (a physician) and an outsider (a student in medical anthropology) observed various activities. The study identifies three key elements in physician habitus that affect SDM implementation: a strong emphasis on medical evidence in meetings and patient interactions, a collaborative approach involving a team of professionals, and a tendency to assume patients’ preferences rather than actively inquiring. The study underscores the imperative to enhance SDM by refocusing medical training, physician group meetings, and clinical guidelines to place greater emphasis on patient perspectives. This collective effort aims to better integrate patient preferences into the patient workup process, fostering the development of a more SDM-friendly physician culture. Chapter 5 explores provider-related attributes of SDM, investigating how physicians rank SDM cases in comparison to other cases, using ‘job satisfaction’ and ‘complexity’ as criteria. The study presents participants with ten vignettes, including SDM, emotionally challenging, and technically demanding cases. The results indicate that participants derive greater satisfaction from technical cases compared to emotional or SDM cases. Technical cases are also perceived as less complex than emotional cases, with inconclusive evidence regarding the complexity of SDM cases. The study suggests that the lower job satisfaction with SDM tasks might be due to them falling outside physicians’ comfort zones. To improve SDM implementation, the study recommends integrating SDM into daily routines and promoting a cultural shift that addresses non-technical issues. Chapter 6 adopts the Diffusion of Innovations (DOI) theory to comprehensively understand the adoption of SDM in clinical practice, focusing on the ‘knowledge’ and ‘persuasion’ stages of DOI theory. Through prior research data and additional interviews, the study explores the A
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