2 The effect of training and education at the outpatient clinic 29 2.2 Setting and participants This study was conducted at the internal medicine outpatient clinic of the University Medical Centre Utrecht (UMCU), a tertiary care teaching medical centre in the Netherlands. Physicians Eligible physicians were residents and specialists working at one of the outpatient clinics in our university hospital. Specialties at this outpatient clinic are general internal medicine, endocrinology, diabetes, nephrology, infectious diseases, immunology, vascular disease and gastroenterology. Exclusion criteria were participation in the pilot test of the e-learning module (which was used in the training), and awareness of the purpose of the study (e.g. involvement in an earlier stage or research meeting). Eligible physicians were recruited by the research team and informed that the study was about patient-doctor communication, consultations would be video-taped, and they had to fill out a questionnaire for each participating patient. They were not informed that the focus of this study was the discussion of care decisions. Written informed consent was obtained, after which their schedules were screened for eligible patients. Patients Patients ≥18 years with a scheduled consultation with one of the participating physicians within the study period were eligible for inclusion. The time between scheduling and the actual appointment had to be ≥3 weeks to account for sufficient time for the patient to consider participation and the research team had to be available to obtain written informed consent before the appointment. Visits included routine visits and new patients at the outpatient clinic that were referred by their general practitioner. They visited the outpatient clinic for a variety of indications: renal insufficiency, diabetes mellitus, hypertension, etcetera. Exclusion criteria were insufficient command of the Dutch language (i.e. unable to read and understand the conversation aid and questionnaires), inability to give informed consent and a registered discussion on treatment limitations with their physician within 2 years before the visit. Patients could only participate once.
RkJQdWJsaXNoZXIy MTk4NDMw