73 Studying physician culture in SDM meetings and in first-patient encounters, as treatment advice was made before or without actively eliciting patient wishes. Another explanation for the emphasis on medical evidence may lie in how doctors deal with uncertainty. Oncology care has a high level of uncertainty, and although doctors are aware of this uncertainty, it is in their nature to suppress it. [28] Medical training starts building this rationalist medical approach, as junior doctors are being trained to execute several examinations and tests to subsequently determine the right and neatly labeled diagnosis. So young doctors learn to seek apparent security in data and algorithms instead of learning other ways to handle uncertainty. [28] The same educational capital is visible in the current study setting, with residents being strongly encouraged to familiarize themselves profoundly with medical evidence, while they are hardly encouraged to learn how to deal with individual differences in patient needs and wishes or to gain expertise on communication skills to elicit patient wishes. Another study on culture among physicians showed that medical trainees even learn to avoid uncertainty. It showed that socialization in surgical culture moves students towards traits that mask uncertainty and consolidate status. [29] Even though this was not apparent in the department under investigation in this study, this exemplifies the absence of apt ways to deal with uncertainty. Reaching group consensus can be considered as another approach to deal with uncertainty. Being confronted with the advice of a ‘team of experts’ first, however, limits patients from being true partners in the decision-making process, as patients are in a vulnerable position in an unfamiliar domain. [30] The ‘strong voice’ may help in, for example, reassuring patients, but because the decision-making in the team has already been done, it might also hamper true shared decision-making when presented to patients first. In this study, no patients were present when the team advice was formulated. This phenomenon has been studied by others as well. [31, 32] The authors from the current study do not want to plea for patient presence at tumor board meetings. However, knowledge of patients’ individual needs during group specialist meetings might already, in this stage, prepare for shared decision-making. Doctors in the current study, in general, were positive about addressing patient wishes, but again, the field did not help them. As shown in Box 1, a high work pace was observed, especially at group specialist meetings, with individual patients being often discussed in under two minutes. Furthermore, doctors made decisions about treatment programs at a time when they did not yet know their patients well, in both first-patient encounters as well as in group meetings. Literature shows that in these types of situations, doctors seem to base decisions more on superficial interactive knowledge and stereotypes, and they tend to apply their own value judgments more. [33] When gynecological oncologists knew their patients better, care was tailored more toward patient preferences. [33] Another observational study of tumor board 4
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