90 Chapter 5 Transitioning to the practice implications of our research findings, a notable observation arises despite the conviction that SDM is important and the morally just thing to do, [37] many physicians display signs of the so-called Dunning-Kruger effect, a phenomenon in which people with little understanding of and competence in a particular domain seem to overestimate their performance levels. [38] It is essential to understand more about these phenomena and the psychology of health professionals in general, as studies tapping into these subjects are primarily neglected in medical research. Furthermore, the previously mentioned culture change is required amongst health professionals, which cannot be promoted by simply addressing barriers to SDM implementation. [29] Therefore, for future research, we advocate for studies of SDM that make the psychological and cultural issues of healthcare professionals and patients transparent. In addition, we must know the ‘dark side’ of the concept to understand the implementation delay and prevent naive approaches. Additionally, another future research question might be which kind of patient care SDM can best show quick wins, as visible quick wins can be significant determinants for normalizing SDM in daily healthcare. [15] Our study has several limitations. It quantifies sentiments concerning SDM in practicing physicians as essential stakeholders in the implementation process yet includes only a small set of physicians from within one specialty. Ideally, a bigger sample size with a better spread over several types of hospitals and medical specialties would have been used, leading to improved validity and generalizability of study results. In addition, our vignette study lacks an in-depth consideration of patient variations, including differences in skills, competencies, or opportunities to engage in SDM with their healthcare providers effectively. These variations significantly contribute to the complexity of SDM. [39] Furthermore, we did not comment on the differences between TECH and SDM cases with the appreciation of EMO cases in our discussion section, as these comparisons were outside the scope of our study. Despite our efforts to prevent it, the vignette study could have been subject to framing bias, which occurs when people choose based on how the information is presented instead of the facts themselves. [22] Moreover, the design of the vignettes could have biased the ranking results as well, as we purposely involved more complicated cases, and cases are non-equivalent. Next, we did not register whether participants were trained or skilled in SDM or not; differences in SDM skills present could have influenced results. Sampling was not blinded, and we obtained a higher number of responses in the job satisfaction sample compared to the complexity sample. Finally, the finding that physicians perceive SDM as less rewarding, and complex does not imply that they will refuse to do it. The question remains how to seduce them to enjoy ‘the art of SDM’. Innovation An important strength of our study is the innovative design and the statistical methodology purposefully designed to analyze our study results. Moreover, this is the first time that the concept of SDM has been compared to the appraisal of technical tasks regarding their perceived complexity and job satisfaction ratings amongst physicians. These comparisons, tapping into the psychology of health professionals, are still a largely neglected field in medical research. Nevertheless, those types of studies could provide valuable insights for implementation science.
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