Chapter 7 160 Future perspectives – Research There are some areas still open for future research. Many physicians mentioned it was more difficult to discuss care decisions with patients from another cultural background. In a diverse society, it is important to develop cultural sensitivity and connect with people from different backgrounds as well. In a topic such as care decision conversations, in which communication plays a key role, it is important to further explore the best way to involve patients with different backgrounds. These can be different cultural backgrounds, but also (health)literacy or a language barrier influences how best to involve the patient in care decision conversations. We focused our research on two settings, the outpatient clinic and emergency department. The recently published guidance document from the Dutch Federation of Medical Specialists on when to discuss care decisions in acutely ill patients, provides room to postpone the care decision conversation to during admission at the ward. How desirable this is, is a question still open. In our opinion, future research should not focus on whether one setting is ‘better’ than the other setting, but on how we achieve to engage patients and physicians in these conversations in every setting. Next to the individual patient educations we studied, future research could focus on ways to create and maintain public awareness. The increased awareness during the COVID-19 pandemic suggests this could enable care decision conversations. However this increased awareness seems to be waning. One could think of several ways to create public awareness (media attention, a public campaign), more focused on individuals (a letter on your xth birthday, as with the donation register) or directed to patient populations (poster or video in waiting rooms, information on websites), the possibilities are almost endless. The most important challenge for these interventions is to emphasis the relevance. To address the perceived irrelevance properly, it might be useful to join forces with the behavioral or psychological field. To start, spread and hold the ‘new’ narrative: care decision conversations as a normal, regular, recurring part of the consultation to align treatment with patients goals and values. Although we directed our research to physician-patient communication about the topic of care decisions, there are some pioneering studies that experiment with involving other healthcare professionals such as dedicated nurses. An interesting development that warrants further investigation as well.
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