Chapter 4 86 ‘sensitive’, ‘clear’, ‘open’, ‘trustworthy’, ‘attention for the person’, ‘treating the patient as an equal’ or just ‘good communication’. This demonstrates the need for a sensitive and empathic communicative approach: physicians should take into account their communication style. Another common opinion amongst patients is that the physician should initiate the care decision discussion. This was most often mentioned in relation to the question what would be necessary or helpful to discuss care decisions. Patients related this to the sensitivity of the topic, for instance, ‘because people are hesitant to think about it, it would be better if someone else starts talking about it’, or to the perceived current irrelevance, for instance ‘because people are not thinking about that yet’, ‘if the physician makes the assessment it is relevant for this person, then the physician should also take initiative’. The physician is also assigned a task in informing the patient and resolving the knowledge deficit: ‘as a patient you don’t think of all the things that the physician can think of’. A minority of the patients fully trusted their physician’s expertise and preferred to leave the decisionmaking up to the physician. Most stated that the physician should inform them about treatment options, pros and cons, risks and chances of recovery: ‘if you choose not to do this, this is what it means, and also what it means if you choose to indeed do so’. The physicians role is not limited to informing. Patients also stated the physician should ‘make you really consider so really ask the questions’, in order to help the patient make up the balance. The physician can/ should enable the patient to take charge: ‘the patient should feel they have a choice (…) and they are free to make choices’, ‘the physician might know better, but the patient should know what he wishes’, ‘that the patient is made to think about it and that he dares to speak’. Finally, patients stated it is important that the physician is aware of their patient’s opinion, and is assigned the role as registrar of this opinion. Because the physician is connected to almost all other (sub)themes, we visualised the physician as a wheel at the centre of Fig. 2, able to initiate and generate discussions, taking into account all themes perceived as relevant by the patients.
RkJQdWJsaXNoZXIy MTk4NDMw