68 Chapter 4 However, patient encounters following initial treatment were much less focused on medical evidence and executing protocol-led care, providing more room for patient perspectives. A young woman comes in for a follow-up visit 1.5 years after the initial treatment for a gynecological cancer. She asks the doctor: “Wouldn’t it be valuable for me to have a scan so I can feel reassured?” After initially explaining that reigning guidelines state that scans do not contribute to a ‘good workup’, the doctor and patient still agree on performing a scan since they both think this would reassure the patient. (Source: observation of a patient-doctor encounter) In this case, no guideline prescribed the extra check, yet the doctor listened to the patient’s wishes, and together, they agreed to perform a scan. This conversation exemplifies how gynecological oncologists respect patient perspectives within their clinical encounters when brought up. Observations showed that, especially when palliative care was indicated, patient wishes were elicited more often than when a cure still seemed possible. Box 1. A typical patient workup at the gynecological oncology department On Tuesday morning at 9:30, the weekly meeting to discuss all referrals and planned surgeries starts. Five gynecological oncologists, two residents, and one nurse are present. First, all upcoming surgeries are discussed, and afterward, one of the residents presents all new patient referrals, planned for the afternoon. One of the new patients, Mrs. X is a 50-year-old woman diagnosed with vulvar cancer. Information available from the referring hospital is presented, mainly consisting of biopsy results and characteristics of the vulvar lesion. The presenting resident is questioned about the reigning guidelines on diagnostic workup and treatment of vulvar malignancies, and a preliminary plan for workup and treatment is briefly discussed. Both residents and gynecologists seem well-informed about the guidelines, and they quickly continue discussing the next patients. There is not much time, as the weekly multidisciplinary tumor board meeting will immediately follow this meeting and must, therefore, finish on time. The tumor board meeting starts at 11 a.m. sharp. All previously mentioned professionals are present, supplemented by an oncologist, radiologist, pathologist, and radiotherapist. There is also an ‘audience’ present, consisting of five researchers working in the field of medical oncology. At the tumor board meeting, results from diagnostic and therapeutic procedures are discussed. The multidisciplinary team then formulates a recommendation for treatment for a particular patient. Most recommendations are formulated in accordance with current guidelines or medical evidence from contemporary medical trials. The tumor board meeting is characterized by a high pace since results from 30 to 40 patients are addressed each week.
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