88 Chapter 5 Table 3: Case vignette type pairwise comparisons per preference category for ‘complexity’ ranking. Case vignettes per type and preference category for ‘complexity’ ranking Observed sum of case vignettes per category SDML EMOL TECHL SDMH EMOH TECHH 15 5 25 17 16 12 SDML 15 0 10 (p=0.037)* -10 (NS) EMOL 5 -10 (p=0.037)* 0 -20 (p=0.001) TECHL 25 10 (NS) 20 (p=0.001) 0 SDMH 17 0 1 (NS) 5 (NS) EMOH 16 -1 (NS) 0 4 (NS) TECHH 12 -5 (NS) -4 (NS) 0 SDM is shared decision making, EMO is emotional, TECH is technical. L or H in the subscript refers to the low- or high-ranking category, respectively. - All significance tests are performed according to the algorithm based on randomization tests, as described under Statistical analyses and in the Appendix. - For each comparison in the cross-tabulation, the value is calculated by subtracting the vignette count in the horizontal row from the count in the vertical row; between brackets, the p-value is provided from the 2-sided p-test; only significant p-values (p < 0.05) are displayed; NS means non-significant - Irrelevant cells are left empty *) non-significant after Bonferroni correction Discussion and Conclusion Discussion Curious about the reasons behind the internationally reported delay in implementation and inspired by SDT and DOI theory, we set out to study two aspects of SDM: the job satisfaction it would offer physicians and the perceived complexity of the concept. Results are inconclusive about whether doctors find SDM complex, yet they provide some clues for explaining the lack of SDM implementation. Compared with technical cases, our study suggests that participants get less job satisfaction from SDM. When comparing technical cases to all others, we observed a trend in our data that gynecologists rate these technical cases as less complex yet provide higher satisfaction levels. These results hint that gynecologists might look more for predictable outcomes from technical activities within their comfort zone. Subsequently, SDM cases might not be within the gynecologists’ comfort zone. These propositions raise several questions. The first question is what causes SDM not to be within a physician’s comfort zone. One explanation might be found in the psychology of human decision-making itself. Research within this domain shows that people prefer familiar
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