General introduction 17 1 Outline of this thesis: Part I Part I focusses on care decision conversations at the internal medicine outpatient clinic. In Chapter 2, we investigate the impact of physician training and patient education (both on the topic of care decisions) on patient satisfaction and physician preparedness. Chapter 3 provides a conversation analysis of authentic care decision conversations at the internal medicine outpatient clinic, offering insights into the communicative challenges and strategies employed by physicians and patients. In Intermezzo 1, we show insights in the physicians’ perspective and connect these to the results of Chapter 2 and Chapter 3. Part II In part II we focus on the patient perspective. In Chapter 4 we explore the patient perspective on care decisions through a qualitative interview study, shedding light on patients’ experiences and preferences regarding these conversations. In Intermezzo 2, we show parts of the physicians’ perspective that relate to these topics. Part III In part III, we look into care decision conversations at the emergency department. In Chapter 5, we investigate the impact of the worldwide COVID-19 pandemic on code status documentation upon admission in a descriptive cohort study. Given the research restrictions in the beginning of the pandemic, we utilized available documentation and registration instead of focus on quality and patient satisfaction as we did in our other studies. In Chapter 6 we evaluate a combined approach of physician training and patient education aimed at improving quality of care decision communication at the emergency department. We investigated the effect on patient-assessed quality of care decision communication. Intermezzo 3 shows some final insights from the physicians’ perspective. Part IV In Chapter 7, the final chapter, we will discuss the main findings of our investigations, implications for daily practice, and directions for future research, training and education.
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