Chapter 2 30 Patients were contacted by phone by the research team and informed that the study was about patient-doctor communication, half of the participants would receive an online conversation aid and the consultation would be video-taped. They were unaware of the topic of the conversation aid and focus of the study. After verbal informed consent was obtained, participants were randomized. Patients in the control group received an e-mail with the same information as discussed during the phone call, whilst the intervention group received an e-mail with information about the topic of the conversation aid, along with the web link to the conversation aid. Written informed consent was obtained directly before the outpatient clinic consultation by the research team. The outpatient clinic consultations were video recorded for qualitative analyses, of which the results are reported in a separate publication (13). The video camera was visible in the consultation room and both patient and physician were aware of (and consented to) the whole consultation being video recorded. Immediately after the consultation, both the patient and the physician received a separate questionnaire (complete questionnaires in supplementary appendix 1). 2.3 Interventions Physicians’ training The physicians’ training consisted of an e-learning module and a handson training with a simulated patient (i.e. an individual trained to act as a real patient). More detailed information can be found in supplementary appendix 2. After the training, physicians were aware that care decisions were the main focus of the present study. However, physicians were instructed to do their consultations with participating patients similar to those with non-participating patients (i.e. they should not discuss care decisions solely because ‘the camera is on’). Patient education: conversation aid The conversation aid for patients was an online application in which patients could find comprehensible information about why it is important to discuss care decisions, what certain treatments entail and what possible treatment limitations are. Written information was accompanied by visual material. Hyperlinks to additional information were included. The conversation aid was
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