Dunja Dreesens

110 “The patients remember only 20% of what’s being discussed. And, because you can give it to take home, it means that people don’t need to make on the spot decisions during consultation.” 14 “I’m not sure if these make it much clearer. It could also complicate matters for patients, these kind of choices.” 7 “I think it’s a lot of text. I don’t think patients will read it.” 9 “It’s more of a checklist for myself, not something you go through together.” 11 Usefulness of PDAs to pediatricians “When I look at it, I immediately notice that it covers a dilemma we deal with a lot. And it is actually a nice format, so I definitely think it’s of use to us. Can you email it to me?” 6 “I think so. It shows you the experience of others in these instances, what they did. And it also gives you an idea of what to ask in cases you yourself are a bit hesitant about.” 11 “Sometimes when talking to parents, you notice they get confused, and you need to tell more. If you can show it with visuals like this, is even better.” 13 “Yes, I think it’s really practical: not a lot of text and it looks appealing. Most of it, is in your head, but this makes the considerations really explicit. And translates it directly to aspects patients care about.” 15 “It doesn’t need to be part of a guideline, I can do it myself.” 1 “I’d prefer to explain it myself. It is part of being a doctor. You’ll notice a response, a hesitation. And as a doctor, you prefer some medicines yourself, because you’re more familiar with them and you’ll advise those.” 4 “No, I can do that myself. I’m more inclined, on the basis of my experience and taking the patient into account, to take the lead and say: ‘I think this is the best medicine’.” 7 “I think I can explain it easily in 5 minutes. The question is whether that is true. Okay, you’re making me reconsider my answer.” 7 “I don’t think I would use it. I feel a bigger urge to look the patient in the eyes and tell them what’s it about.” 10 “I don’t think it’s right. I suppose additional explanations are needed? But, I think they’re risky, because it will affect the verbal communication negatively.” 13 Discussion Several participants acknowledged the added value of SDM being included in the guideline PCFC, and more participants were of the opinion that guidelines in general potentially could enhance SDM. Regarding the specific SDM-recommendations in the PCFC guideline, several participants judged these as stating the obvious and lacking detail and practical guidance. Some even said they were offended by these recommendations, perceiving it as an attack on their professionalism because they already do this. Clinical observations, however, have shown that SDM during patient contacts is not standard practice yet. Clinicians think or say that they practice SDM, but when their interactions with patients are analysed, it appears that the level of SDM leaves room for improvement (67, 68, 252, 269, 270). The felt attack could perhaps be unjust because of optimistic bias. Furthermore, research suggests that there seems to be a tendency with clinicians to share non-treatment related decisions with patients, and to share the treatment related decisions to a lesser degree (271, 272). When it concerns children, this could be expected as parents and health professionals might take a protective stance towards the child. However, the child might prefer to be protected in some situations and wants to share decision-making in other situations. In addition, some children prefer to leave the more ‘serious’ decisions to their parents and healthcare professionals, whereas other children prefer to share the decision (261, 273). The Chapter 6