Background: Shared decision-making plays an important role in ensuring value-based healthcare in cardiac surgery. However, the personal situations of patients in cardiac care have not been widely explored, and thus, little is known about the decision-making experiences of patients and their relatives before surgery.Objective: To explore the perceptions of patients indicated for cardiac surgery and their relatives during the decision-making process, as well as their experiences of a conversation aimed at achieving shared decision-making in the treatment trajectory.Methods: The data were collected through semi-structured in-depth interviews with patients aged ≥70 years who were indicated for cardiac surgery and their relatives until theme saturation. Both inductive and deductive analysis were conducted based on the principles of reflexive thematic analysis.Results: Interviews with 16 patients and 10 relatives provided in-depth insights into the experiences of patients and their relatives in terms of a shared decision-making process prior to surgery. Overall, 15 subthemes were identified, and these were divided into three themes. In general, the patients' experiences and perceptions were influenced by their (1) general daily functioning. The relatives were more concerned about (2) social expectations and (3) existential uncertainty.Conclusions: Patients eligible for cardiac surgery and their families have unique experiences and perceptions during the process of shared decision-making. The subthemes emerging from this study, such as the overestimation of potential medical outcomes by patients and their relatives, who experience fear about the current health situation of their loved one, require careful attention from healthcare professionals during decision-making conversations.
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Ondanks alle magere jaren presteren aandelen beter dan je zou verwachten toont deze analyse aan. Ze zijn nog steeds onmisbaar voor het opbouwen van een goed pensioen.
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Na een korte inleiding over Yunus, één van de grondleggers van microfinanciering voor armen, wordt de opkomst van de microfinanciering besproken. De toenemende rendementen in de sector zorgen er voor dat private beleggers hierin gaan deelnemen. De veranderende dynamiek die hiermee gepaard gaat komt uitgebreid aan de orde. De kritische houding van klanten zorgt voor De Client Protection Principles, die voor meer bescherming moet zorgen. De klanten weten wat ze willen of niet willen en zij doen in grote getalen mee. Dat hoeven we toch niet eng te vinden?
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