PhD defence H. (Haske) van Veenendaal

Below is a brief summary of the dissertation:

SDM is defined as a collaborative process that integrates patient values and preferences with clinical evidence about available options and their risks and benefits, to arrive at patient-centred decisions about diagnosis, treatment or follow-up when more than one medically reasonable option is available [9, 10]. Four elements of SDM are considered as essential [14, 15]:

1. The clinician informs the patient that a decision is to be made and that the patient’s opinion is important
2. The clinician explains the options and the pros and cons of each relevant option
3. The clinician and patient discuss the patient’s preferences; the clinician supports the patient in deliberation
4. The clinician and patient make or defer the decision and discuss possible follow-up.

Although SDM has been shown to be effective, SDM is not widely used in everyday clinical practice [28, 29]. However, SDM has generated so many positive expectations among patients, clinicians, and policymakers that it has now become an ethical necessity. Determining the effectiveness of an innovation such as SDM, does not mean that it can be easily applied in daily practice [30]. Therefore, it is necessary to reveal what would accelerate the implementation of this approach in practice [27].

The aim of the thesis is to answer this question and better understand which barriers and facilitators are involved in slowing or accelerating the adoption of SDM. Therefore, multilevel implementation approaches are evaluated that address organisational and socio-political aspects related to implementation, as well as how SDM tools and theory are presented to practice and how clinicians' behaviour can be influenced.