7 General discussion and summary 157 appropriate moment was during an admission at the ward (44%) (chapter 6), which would endorse the recommendation in the guidance document that this conversation can sometimes be postponed to hospital admission. Limited time is a complicating factor in both settings. In the emergency department, time is limited because the patient can be acutely ill, but also because of overcrowding and the need to keep turnaround times as short as possible. At the outpatient clinic, time (per consultation/ patient) is limited as well, which results in physicians’ prioritizing other conversation topics over care decision discussions (intermezzos). Multiple perspectives Our final overarching learning point is not so much about the content of care decisions or the answer to our research question, but about the way in which we attempted to answer our research question. Bringing together multiple perspectives, both in the research population (patients and physicians), research methods (quantitative and qualitative: interviews and conversation analysis) and research team (physicians, a language and communication scientist, educator) proved to be very valuable. We found many similarities and themes that recurred in the different studies, which triangulated the results. It also contributes to determine which targets are most important for future interventions and research. The fact that ‘relevance’ resonates in all studies, regardless of the population, setting or method, shows the importance of addressing this relevance. Bringing together multiple perspectives showed that different ‘glasses’ might use different words to describe the same phenomenon, and to look through these other ‘glasses’ and the implications of these other words can be very insightful. For example, in the adjusted physicians’ training, we showed physicians that the ‘hooks’ to introduce the topic of care decisions that physicians searched for (intermezzos), were the same as ‘accounts’ that conversation analysis of real outpatient clinic conversations revealed (chapter 3). The accounts are used as a justification, and we found several accounts, patient related and external. This insight made the physicians aware of why they were searching for a ‘hook’, and that different accounts can have different implications.
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