7 General discussion and summary 151 status documentation and (documented) code status discussion. However, in the COVID-19 cohort more patients had treatment limitations and within the limitations, ‘no intubation’ and ‘no ICU admission’ were substantially more prevalent. Although our study was not designed to differentiate between possible explanations for this difference, baseline characteristics and subcomparisons indicated that it was not (just) patient or disease related factors (e.g. clinical severity, age, comorbidity, type of infection), so other forces were at play. We assume awareness played a huge role in this. Awareness amongst physicians, in a time with high pressure, tasked with the judicious allocation of limited resources to those patients most likely to benefit. This might have made the physicians take a more restrictive stance or elaborate more extensively on the negative impact of certain treatments. But we assume awareness amongst patients and the public contributed as well. There was a lot of attention on media platforms showing the realities of invasive procedures such as intubation and intensive care, thereby showing the potential severity of their implications. The quality of the conducted conservations and attention to other aspects of care decision discussions, like goals and values of the patient remain unclear. However, the higher frequency of treatment limitations might indicate a more considered decision-making process. Previous research shows that a well-informed patient often results in a more restrictive policy (3–6). Altogether, the results of this study suggest that creating (public) awareness for care decisions could improve care decision conversations, something that can be implemented and contained in the post pandemic setting as well. Adaptations to the physicians’ training and patient education Within this project we adopted the lessons we learned from our previous studies, and adjusted the physicians’ training and patient education. Main adjustments to the physicians’ training were more emphasis on the relevance of care decision conversations and the wide range it comprehends (i.e. it is about more than the resuscitation question, attention to the goals and values of the patient). Another add was to highlight the key role the physician plays in the patients point of view. Furthermore, we incorporated learning points acquired from the conversation analytic study. We included some example utterances and discussed the interactional implications of these utterances.
RkJQdWJsaXNoZXIy MTk4NDMw