89 Studying physician-related attributes of SDM alternatives over unknown alternatives. [27] In general, selecting a familiar option is preferred. [27, 28] As SDM is associated with uncertainty, with less control over physician-patient interaction and potentially different results than medical guidelines advise, it is understandable why it is not within the physician’s comfort zone. [29] These findings align with SDT, which underscores that increased autonomy and competence are more comfortable within the zone of familiarity. [17] The second question is whether bringing SDM within the physicians’ comfort zone would still be possible. Providing doctors with a sense of control by familiarizing them with SDM concepts might help. For example, by teaching doctors how to master SDM skills better and educating them in dealing with uncertainties in doctor-patient communication and subsequent out-of-protocol healthcare choices. [29, 30] Or even more practical, by providing them with more decision aids to help them structure the consultation according to SDM principles. [31, 32] Training initiatives and decision aids have increasingly been developed over the past few decades, [32, 33] so this seems to be an easy fix to the previously presented problem. Nevertheless, extensive training is still minimally implemented, and decision aids are only relatively little available in the medical workspace. Furthermore, results from training interventions described in research do not yield encouraging results, as many studies do not show positive effects like increased or better use of SDM by doctors. [32, 33] Normalizing SDM use by integrating it into physicians’ daily working routines might better reduce physicians’ levels of uncertainty or unfamiliarity. For example, by standard addressing SDM in any (multidisciplinary) team meeting and at all patient case discussions and incorporating SDM principles in every clinical guideline. [29] Unfortunately, SDM is still far too often considered ‘different’. Even in our current study, we started from the position that we need to think about change: changing the culture, engaging, and enabling the organization, and implementing and sustaining the change. [34] It is time for us to leave the we-still-need-to-make-a-change standpoint and begin normalizing SDM as an element of ‘the air we breathe’ as healthcare professionals. However, a further question is whether attempts to put SDM within the physician’s comfort zone would mitigate its backlog on technical tasks. Previous research shows that the most often mentioned reasons to pursue a medical career are helping people and their interest in medicine. [35] Against this background, would physicians learn to appreciate being confronted with potentially more demanding patients or not? A culture change will be needed for doctors to appreciate these non-technical aspects of their profession. [29] Previous study results provide hope for the future of this culture change. For example, an extensive international survey among general practitioners confirmed that performing technical tasks is related to higher job satisfaction; however, patient satisfaction is even more connected to physicians’ job satisfaction. [36] If SDM delivers its promise of more satisfied patients, it could compete with technical tasks by yielding equal or even better job satisfaction scores. 5
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