Theme: | Possibility (or desirability) of CPGs encouraging the practice of SDM Illustrative quote | Interview # |
---|---|---|
Useful/helpful | ||
“Perhaps it could help a clinician who is SDM-minded, but doesn’t dare. I mean, if you aren’t experienced in palliative care yet, it can be quite, um, scary.” | 3 | |
“Sure, especially when it comes down to points of disagreement, it can be helpful to choose a certain direction. In other guidelines, it is mentioned explicitly that you need to check with other specialists before you proceed. And with the patient and parents, of course.” | 4 | |
“For some aspects, it could be the case that you yourself don’t consider them, or that you are partial to certain things. But by mentioning all the aspects in a structured way in the guideline and discussing these with the patients, all topics that matter are covered.” | 12 | |
“If you go through a list the patient probably thinks that you are a meticulous doctor who makes sure to tick all the boxes. However, it can also appear as being callous because it is not a conversation, you just go through the list.” | 3 | |
“It must be useful when your peers have thought about it and decided to add recommendations on SDM, to support you or make it easier for you to do it yourself.” | 11 | |
“It means you can adhere to the guideline more often without you having to explain time and again why you didn’t adhere.” | 14 | |
Guidelines are paternalistic | ||
“A guideline will not immediately contribute to SDM. SDM depends on communication. And a guideline can obstruct that, as it says ‘do this’ and some people will claim that they are legally required to follow the guideline.” | 13 | |
“Often guidelines say do A, B or C. They don’t say consider A, B or C because there’s the same amount of evidence. And if it would say consider A, B or C then you can discuss it with the parents.” | 1 | |
SDM is an attitude/skill | ||
“You don’t need a guideline on how to have a conversation.” | 9 | |
“If doctors don’t do SDM, a guideline will not make them do SDM.” | 1 | |
“I think that the way you involve the parents is ‘the art of medicine’ and not medicine. So, I think it comes down to the competencies of the doctor. You can’t capture those in a guideline.” | 2 | |
SDM irrespective of guideline subject | ||
“I don’t think it will help to integrate SDM in the guideline. A guideline helps when there’s no common sense. This is common sense.” | 10 | |
“Maybe we need a guideline on SDM; namely involve the parents and the patient with every choice concerning their care. These two lines, easy as that.” | 1 |