Exploring Shared Decision-Making | 85 3 Discussion Main findings This study explored the current state of SDM in the complex setting of HN oncology. Although both surgeons and patients perceived a relatively high level of SDM, participation in SDM during consultation was observed to be lower than reported. Moreover, when looking at patient involvement, we found that both patients and surgeons mostly preferred a collaborative approach to the decision-making process. In almost two-thirds of the cases, surgeons’ assumptions aligned with patients’ preference for involvement. However, the mismatch in the remaining cases and the nine consultations that had not taken place as preferred by the patient demonstrate that discordance in surgeons’ and patients’ perceptions of decision-making roles is still commonly present. Furthermore, the duration of the consultation and patient OPTIONscore were correlated with the observed SDM level of surgeons. No other associations were found. Interpretations and comparing studies Overall, surgeons in our study were observed to apply SDM moderately, with a median total OPTION-score of 48.0%. This finding was somewhat contrary to our expectations, as it indicates a somewhat higher level of SDM compared to what has been reported in other studies33, 34, 39, 40, 53, 54. One explanation for this higher OPTION-score may be that treatments for HNC are extensive and have a significant impact on patients’ OoL, requiring a trade-off between survival and organ preservation through elaborate discussion23, 55, 56. Consequently, the higher score observed was primarily due to surgeons effectively discussing the (recommended) treatment option(s) (OPTION item 4). However, this tendency still reflects a common physician behavior that may hinder the full implementation of SDM, even if they express support for it57. It is important to note that the surgeons performed less well on those OPTION items (i.e., item 1 ‘goal talk’, item 5 ‘decision talk’, item 6 ‘integrative decision talk’, and item 7 ‘evaluation talk’) that specifically address SDM behavior, suggesting room for improvement in these areas. Similar to surgeons, patients were observed to participate moderately in the decisionmaking process (median total OPTION-score 42%), scoring low on asking about alternative treatment options (OPTION item 2) but moderate on all other items. On the other hand, caregivers participated considerably less during consultations (median 24%), with median score indicating low participation across all OPTION items. While our primary focus was on the performance of surgeons and patients as key actors in the decision-making process, caregivers are often involved in patients’ care. Although we did not delve into caregivers’ contributions further in this study, exploring the dynamics
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