Chapter 3 48 2. Methods 2.1 Study design This study is part of a larger project aimed at stimulating and improving care decision conversations at the internal medicine outpatient clinic of University Medical Center Utrecht, a tertiary care teaching medical center in the Netherlands. This study was approved by the Medical Ethical Testing Committee Utrecht (MEC 18-465) and registered in the Dutch trial register (NTR 7188). Eleven physicians (residents and staff physicians) from different specialties of the department of internal medicine participated in this study. A total of 185 of their patients agreed to participate. Randomization software was used to randomly select patients, stratified by gender, who were assigned patient education*. Physicians were trained** halfway through the study period. This resulted in four groups: 1) physicians before training and patients without patient education; 2) physicians before training and patients with patient education; 3) physicians after training and patients without patient education; 4) physicians after training and patients with patient education. This project involved both quantitative and qualitative analysis. This paper focuses on the results of the qualitative analysis. 2.2 Video recordings The outpatient clinic visits were video recorded for purposes of qualitative analysis. Since the consultation rooms had different set-ups, the extent to which both participants were visible varied. Figure 1 shows that we set out to record 185 consultations. Thirty-five recordings failed for various reasons, for example camera malfunction, last-minute location change, or camera inadvertently not switched on. This means that the resulting dataset consists of 150 recordings. 2.3 Analysis All video recordings were assessed by one of the authors (SB) to determine whether or not the consultations involved a discussion of care decisions (see our description in section 1). The recordings in which care decisions were discussed were transcribed verbatim. To identify when care decisions were discussed, we used Heritage & Clayman’s (2010) framework of phases in
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