Table 4 Illustrative quotes on added value of SDM integrated in CPGs
Theme: | Added value of SDM integrated in the guideline PCFC and guidelines in general Illustrative quote | Interview # |
|---|---|---|
SDM-recommendations in guideline PCFC | ||
“I feel that a disadvantage of this guideline is that, even though it is corroborated by evidence, that the recommendations state the obvious.” | 1 | |
“If you write it down in such detail, I would like to know the added value for myself. What’s in it for me when I have to deal with a high complex situation? However, do I think everyone applies these SDM-recommendations all the time in practice? No.” | 10 | |
“If you are inexperienced, you can read these SDM-recommendations. I think it’s nice, but they are not really practical.” | 3 | |
Modified multi-option (SDM) recommendation | ||
“It’s more agreeable. Also, because it contains the lines of reasoning.” | 6 | |
“It provides more information, more possibilities to consider.” | 11 | |
“This does represent the actual situation you’re dealing with in practice. Do you as a doctor take the lead, or do you provide more options? So that the parents are in a position to choose as well.” | 7 | |
“For the more complex decisions, of which there many in palliative care, it is beneficial to indicate the whole spectrum of care.” | 12 | |
“It will probably, even if it’s only subconsciously, prompt you to explain more to the parents, such as harms and alternatives, because it’s right in front of you.” | 5 | |
“Nothing is black and white. And then it is nice that the guideline also provides alternatives that meet a certain standard; it prompts you to more discussion on what to do.” | 14 | |
“The SDM-recommendation requires more deliberation and demands more of your communication skills.” | 13 | |
“I would like to know the evidence base of each item mentioned. If it’s part of the guideline, I would question if it was properly assessed.” | 10 | |
“And, there is of course a balance in what makes a guideline practical. You cannot include all the literature, because then it would no longer be a practical guideline.” | 15 | |
“If you want you can put everything in a guideline. I don’t believe that’s the way to go.” | 5 | |
“Especially for the doctors who are being trained, nurses and physician assistants who are less experienced, have less knowledge, they will need a very clear guideline.” | 13 | |