A patient’s perspective on care decisions 77 4 2. Methodology 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 the University Medical Centre Utrecht, a tertiary care teaching medical centre in the Netherlands. We conducted a descriptive qualitative study with a phenomenological approach to explore patient’s perspective on the topic of care decisions and the patient education. This study was approved by the Medical Ethical Committee of the University Medical Centre Utrecht (MEC 18–465). The study procedures comply with the Declaration of Helsinki. The study was reported using the consolidated criteria for reporting qualitative studies (COREQ) (see supplementary appendix 1) [16]. 2.2 Participants We used convenience sampling to select participants that had received the patient education in a clinical setting (i.e. the intervention group of the previous study). In this previous study, patients over the age of 18 with a scheduled outpatient visit with a participating physician, were eligible for inclusion. Physicians belonged to the department of internal medicine, nephrology, gastroenterology, endocrinology, immunology or vascular medicine. Exclusion criteria were: inability to read Dutch, inability to give informed consent, or recently (<2 years) documented treatment limitation discussion. All patients that gave permission to be approached for further researchquestions, were contacted for this particular study. They were informed about this subsequent interview-study by phone, and asked for verbal informed consent. When verbal informed consent was given, interviews were planned and executed by phone. Figure 1 shows the inclusion of patients. In two rounds, a total of 44 patients were interviewed, 34 patients in the first round and 10 in the second round. Interviews were conducted in two rounds for both practical and methodological reasons: the former study was not ended yet during the first round of interviews, so new eligible patients were available after the first round, and this gave us the opportunity to adjust our interview guide in-between the rounds based on our first analysis. One interview was only partly recorded due to a technical issue. Of the 44 patients, 25 were male (56,8%) and 19 female
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