Chapter 7 146 “Not everything that counts can be counted, and not everything that can be counted counts.” - William Bruce Cameron In this thesis, we investigated how care decision conversations can be improved. For this purpose we developed a training for physicians and educational materials for patients. Both items were implemented and evaluated in different settings: the outpatient clinic (chapter 2) and emergency department (chapter 6). We used conversation analysis to gain insight in how authentic care decision conversations are currently conducted (chapter 3) and what we can learn from this. Furthermore, using semi-structured interviews we explored patients’ (chapter 4) and physicians’ (intermezzos) perspective towards care decisions. This provides further insights into possible targets to improve care decision conversations. During our research, we had to cope with the COVID-19 pandemic, which affected our research as it has affected virtually everything and everyone. This provided the unique opportunity to describe the effect of an extremely high pressure situation on code status documentation (chapter 5). Before the study at the emergency department, we adapted the physician training and patient educational materials. We made adaptations based on the results of the prior studies as well as to fit the different setting. To summarize, we attempted to answer the question “how can care decision conversations be improved?” by answering several subquestions: “how are care decision conversations currently conducted?”, “What are patients’ and physicians’ perspectives towards care decisions and care decision conversations?” and “what is the effect of physicians’ training and patient education on care decision conversations in different settings: the outpatient clinic and the emergency department?”. In this chapter, we will first discuss our main findings in relation to our study questions. Subsequently, we discuss some limitations to this research. This is followed by three overarching learning points. Then, we summarize all the necessities for a care decision conversation using a metaphor of a dance between patient and physician. We conclude with future perspectives for research and clinical practice: how to reach that perfect dance. What is the effect of physicians’ training and patient education on care decision conversations at the outpatient clinic? Inspired by the Wise Choice of the Dutch Association of Internal Medicine (NIV) (1), we set up a study to investigate the effect of physician training and patient
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