136 Addendum challenges and dynamics related to SDM adoption for more patient-centered decision-making. Clinicians value SDM for upholding patient autonomy and enhancing medical practice but face challenges related to its perceived time-consuming nature and compatibility issues between patient and clinician preferences. The complexity of SDM varies depending on the situation and is influenced by colleagues’ attitudes. Clinicians’ decisions to adopt or reject SDM are multifaceted and shaped by their beliefs, cognitive processes, and contextual challenges. To encourage SDM adoption, the chapter suggests practical strategies, including practice assessments, open discussions about the utility of SDM, and promoting reflective practice through professional development initiatives. Chapter 7 provides a comprehensive overview of this thesis’ research findings, focusing on its challenges and addressing the two main research questions. In addressing the first research question concerning the effectiveness of SDM training for residents, Chapters 2 and 3 findings are revisited. The review of SDM training programs in Chapter 2 reveals a significant gap in meeting the fundamental requirements for effective experiential and reflective learning. While Chapter 3 introduces patient feedback as a training component, it becomes apparent that reflective practice does not naturally follow without facilitation. Next, the second research question concerning the factors influencing physician engagement (or disengagement) in SDM is addressed. Chapter 4 highlights the substantial influence of physician culture, characterized by a strong emphasis on medical evidence and an inclination to presume patient preferences. Chapter 5 illuminates how the perceived complexity of SDM leads to reduced job satisfaction among physicians, and Chapter 6 underscores the significance of cognitive dissonance stemming from conflicting beliefs between current practices and SDM. These results indicate the need for a more comprehensive approach to SDM implementation. In the subsequent critical reflection section, four prominent themes emerging from the research findings are examined in greater detail. The first theme highlights the value of training in SDM implementation but emphasizes that it should not be viewed as a universal solution. It is crucial to recognize that training alone does not guarantee competency; workplace experiences and the hidden curriculum are equally influential. Kolb’s learning cycle offers a comprehensive framework for enhancing SDM training, emphasizing the importance of reflective practice. The second theme addresses reductionism as a useful tool in medicine but cautions against oversimplifying SDM. It should be regarded as a virtue or embodiment of ‘good work’, not merely a procedural checklist. The third theme emphasizes the complexity of ‘good work’ in healthcare, recognizing its moral and subjective nature. High-quality SDM involves crafting personalized care plans based on the unique circumstances of each patient. The fourth and final theme examines whether SDM can be seen as a ‘brilliant failure.’ The competition SDM faces from evidence-based medicine in a culture emphasizing measurable evidence is acknowledged. However, the challenges SDM faces offer valuable insights for future implementation efforts. Implications for Practice and Future Research are formulated, emphasizing the importance of embracing SDM’s complexity, and delivering individualized care. Future research should
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