9 General introduction Introduction In 1997, Charles and others presented a pioneering and enduring definition of shared decisionmaking (SDM), which continues to encapsulate this concept’s essence to the present day. [4] In this definition, shared decision-making entails the active participation of both a physician and a patient, where the exchange of information is coupled with collaborative efforts to establish a consensus regarding the most favorable treatment approach. Ultimately, this process results in an agreement on the course of treatment to be enacted. [4] Contemporary research has explored the implementation of SDM, shedding light on a range of issues. Some studies defined the essential competencies that doctors require to apply SDM principles adeptly. [6] Others investigated barriers that impede successful implementation, [7] or reviewed tools, like decision aids, to facilitate this intricate process. [8] A wide range of training interventions has been developed and reviewed, from their inclusion in medical curricula to ongoing development initiatives. [9] Moreover, research underscores the potential benefits of SDM, including enhanced treatment adherence, increased satisfaction among both patients and healthcare professionals, and potentially improved disease-related results, [10] though empirical support for the latter remains limited. [11] However, despite these dedicated efforts, the full realization of SDM’s potential within standard patient care has yet to be attained. For example, practitioners frequently display inconsistencies or insufficiencies in using decision aids, [12] and significant treatment determinations, such as chemotherapy choices, still lack the requisite level of collaborative discussion and preference formation. [13] Furthermore, certain physicians even resist the necessary changes to integrate SDM into their practice effectively. [14] Elwyn and others aptly point out that advocating for SDM as the morally right approach does not necessarily guarantee its consistent application in practice. [11] They express the need for more extensive research into SDM, particularly in dimensions that have received inadequate attention, such as its impact on healthcare professionals. Furthermore, they highlight the imperative of cultivating a new cultural norm within medical practice, centered on ‘deliberation and collaboration’, and the transformation from former paternalistic approaches to a strategy of ‘coaching patients’ in the decision-making process. [11] In this thesis, I will explore the underlying causes for SDM’s unrealized potential within medical care settings, specifically focusing on its application within gynecology. Drawing insights from the social sciences, I aim to uncover the reasons behind the gap between SDM’s ideals and its actual implementation in this field. While existing research has identified substantial barriers impeding the integration of SDM, it has fallen short in thoroughly examining the underlying mechanisms responsible for inadequate application. To draw a parallel with medical terminology, prior studies have explored the symptoms and diagnosis but have not fully elucidated the pathophysiology of SDM’s unsuccessful integration in practice. Gynecology is an apt focal 1
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