Chapter 7 152 Thereby, we addressed the creation of an interactional slot, common ground, use of different kind of accounts, and the paradox of the topic as ‘relevant in the future’ but ‘needs to be discussed now’ (the relevance paradox). Main adjustments to the patient education were ‘patient experiences’: short statements of patients derived from our interviews (chapter 4) and open fields in the questionnaire at the outpatient clinic (chapter 2), to emphasize the relevance and broad spectrum it comprehends. Thereby attempting to disconnect the topic from the end of life and make the relevance more clear. Besides, we shortened the extensive information on various treatments, to be able to pay more attention to the possibility to change one decisions. Finally, we paid extra attention to the language level and created a matching information leaflet. An information leaflet seemed more appropriate to use on the emergency department, the setting of our next study. What is the effect of physicians’ training and patient education on care decision conversations at the emergency department? In chapter 6 we investigated the effect of our adjusted interventions on care decision conversations at the emergency department. Next to this, we applied the learned lessons from previous research to the methodology of this study. As primary outcome measurement, we used a Quality of Communication questionnaire. Thereby keeping the focus on patient-experienced quality, but more specifically than overall satisfaction. The ambition to investigate both interventions separately made the design of our study at the outpatient clinic more complicated and the attempted sample size larger. Besides, research shows educating physicians and patients simultaneously is more effective than either one of them (7). Therefore, we choose to implement the two interventions simultaneously in our study at the emergency department. In chapter 6, we found that the quality of care decision communication improved significantly after our interventions. The number of patient reported care decisions conversations improved as well. This can be the result of more conducted conversations or a higher recall rate of these conversations, both being a valuable effect. A mere 12% of the patients (recalled to have) received the information leaflet, what suggests the physicians’ training had the largest share in these effects. Another noteworthy result we found in this study is that patients are quite divided about what they perceive an
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