88 | Chapter 3 Conclusion This exploratory study revealed that SDM in HN oncology of a tertiary hospital in the Netherlands is being applied to a moderate extent. However, a significant gap exists in the discussion of patients’ values, goals, and preferences, indicating that more attention and involvement from healthcare providers is required. It is therefore essential to raise awareness about what SDM truly entails, especially considering the high prevalence of decisional conflict and regret, that both surgeons and patients tend to overestimate the extent of SDM compared to objective observations, and different perceptions on patient involvement exist. Moving forward, future research in the context of HN oncology should delve deeper into investigating the duration of consultation and patient OPTION-score, as they appear to be associated with a higher objective physician SDM-score. Specifically, exploring how SDM can be implemented without extending the consultation time may contribute to facilitating SDM uptake. Additionally, it is important to explore methods for effectively assessing both observed and perceived SDM levels in clinical practice. Enhancing SDM in HN oncology could lead to better patient and healthcare-related outcomes. As such, addressing the identified gaps in SDM practice is needed for improving patient care and healthcare delivery in this setting. Practice implications Our study offers insight to SDM in HN oncology and presents opportunities for improvement. Although it appears that the majority of patients and surgeons prefer to make the final treatment decision together, we believe that it is the healthcare provider’s responsibility to take the lead in supporting the patient in decision-making, particularly in such stressful situations as HN oncology. This involves assessing the patients’ values, needs, and preferences, taking into account the most relevant clinical evidence available, before making a joint decision about the course of action. Therefore, we suggest that healthcare providers ask as many open (follow-up) questions when discussing patient’s values, needs, and preferences and listen carefully to gain more insight into their patients’ lives, what is important to them, and what doubts, concerns and fears they may have. This is important, as patients’ goals, values, and preferences regarding different treatment options, as well as rounding off the decision-making process during consultations, appeared to require improvement. Furthermore, education and awareness campaigns have recently been launched that highlight the importance and benefits of SDM71. Nevertheless, whilst the concept of SDM has increasingly found its way into medicine and is also included in the vision document for Dutch medical specialists72, HN surgeons tend to overestimate how skilled
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