Chapter 2 40 We are aware that our research may have several limitations. The earlier termination of the study and low participation rate could have led to selection bias. The presence of the video camera in the consultation room could have influenced the conversations and thereby patient satisfaction. A sense of familiarity between the patient and physician could have influenced care decision discussions and patient satisfaction. This ‘familiarity’ might depend on many factors (e.g. number of visits, content of those visits) which makes it impossible to control or correct for. Furthermore, the conversation aid and questionnaires were in Dutch. Our results are therefore not extendable to patients with low literacy or language barriers. Finally, reasons for why neither the physician nor the patient introduced the topic of care decisions was not asked in the questionnaires. Further work needs to be done to establish the best way to remove the remaining barriers to care decision discussions and motivate physicians and patients to engage in these discussions. 5. Conclusion Although the conversation aid for patients and training for physicians did not improve patient satisfaction in this study, these interventions can eliminate some barriers to discuss care decisions: physicians feel more prepared to discuss care decisions and patients are more informed without feeling anxious or sad. The low number of care decision discussions shows there is still a lot of work to be done. Further work needs to be done to establish the best way to remove the barriers to care decision discussions and motivate physicians and patients to engage in these discussions. Acknowledgements We would like to thank all physicians and patients that participated in this study. Furthermore, we would like to thank B. Silvius, I.P Klaassen and C.A.M Joosten (research nurses) and C. van Ginkel (physician) for assistance in recruiting participants and obtaining informed consents.
RkJQdWJsaXNoZXIy MTk4NDMw