Table 1.
Salient beliefs associated with presenting evidence-based dietary treatment options (including the option of doing nothing) during the clinical encounter
| Salient beliefs | Quotes illustrating the belief | Frequency of mentiona |
|---|---|---|
| Behavioral beliefs--perceived advantages | ||
| Improves the patient's adherence to treatment | "Involving the child, even if he is young, in the choice: 'What do you want to try between this and that?' (...) If the child chooses on his own, he is more likely to stick to the treatment." | 4 |
| Allows the patient to make an informed choice | "An informed decision is when he [the patient] knows them all, all the possible options. So it is really more informed, several options are being offered." | 4 |
| Gives control to the patient | "It is not just the health professional who controls the disease, it is also the patient himself." | 2 |
| Gives the patient a sense of responsibility | "I think it would give a sense of responsibility to the patient." | 2 |
| Behavioral beliefs--perceived disadvantages | ||
| Increases the patient's insecurity | "...it could confuse him [the patient] in his decision and then he [the patient] wouldn't know what to do anymore." | 3 |
| Increases the dietitian's feeling of incompetence | "I don't know, maybe that presenting all the options could make some patients see us [dietitians] as being less expert (...) because there are some [patients] who like to come here and have the dietitian say, 'Here is where we are going,' whereas now we seem to present a lot of things and finally, they decide for themselves..." | 3 |
| Normative beliefs--approval | ||
| Physician | "The physician who takes the time to explain the diagnosis..." | 3 |
| Multidisciplinary team | "I would say the multidisciplinary team. Often, we will come to the same conclusions." | 3 |
| Patient | "The patient, for sure." | 2 |
| Patient's family | "The husband, the wife, mostly if it is the wife who is responsible for it all [food preparation] so..." | 3 |
| Normative beliefs--disapproval | ||
| Physician | "It depends on the attitude, some physicians are more authoritative and they'd rather that we [dietitians] say what they told us." | 3 |
| Multidisciplinary team | "Yes, it's true that it could not be well perceived by the team, at first, if the person didn't want to do anything and we didn't help her..." | 2 |
| Dietitian | "I would never offer that option [to do nothing]." | 2 |
| Patient's family | "There are families, sometimes, who don't like us to provide several [treatment] options." | 2 |
| Control beliefs--barriers | ||
| Patient's medical condition | "In my area of practice, yes, sometimes, there may be choices to propose but sometimes, there is no choice. A disease has to be treated and the patient's life depends on it [the treatment] so there is no choice, treatment is imposed. In these cases, it`s not possible to engage in shared decision making." | 4 |
| Lack of time | "Time. When we want to be quick, sometimes it's better to go right to recommendations." | 4 |
| Unmotivated patient | "Maybe the level of motivation. Sometimes, when they [the patients] are not really motivated, you cannot...scare them at first, so targeting only one treatment..." | 4 |
| Poor social/familial environment | "Another barrier for us [dietitians] is not having the family's support, the support of the husband, the support of the wife." | 3 |
| Patient's personality | "It's all a matter of personality, I think. Some [patients] are annoyed at being presented with [treatment options], and we feel like we're wasting our time." | 3 |
| Patient's understanding | "You present all the options, but does the patient understand all the implications..." | 3 |
| Disapprobation by the physician | "If the physician doesn't believe in the treatment that you want to use with the patient, he [the physician] won't support you..." | 2 |
| Hospital context | "You know, here [at the hospital] is not the place for it. They [the patients] are in a bed; they are looking forward to leaving. They are more than one to a room." | 3 |
| Dietitian's professional ethics | "For me, it's about professional ethics." | 2 |
| Control beliefs--facilitators | ||
| Availability of time | "It's easier with patients whom you've seen in several clinical encounters." | 4 |
| Good social/familial environment | "Having a good financial situation, not living in an institution, having the choice to...having control over their [patients' own] lives." | 3 |
| Discussions with multidisciplinary team | "We can meet and discuss cases. Because we can say: I came to this conclusion, we took this decision, we can change and..." | 2 |
| Motivated patient | "The interest of the patient, his or her openness and receptivity to information." | 2 |
| Patient's medical condition | "...who [patients] have chronic diseases, it's less acute..." | 2 |
| Support by the multidisciplinary team | "So the multidisciplinary team must also be part of the process..." | 2 |
| Increased workforce in clinical nutrition | "If our workload were decreased, or if they (the human resources department) increased the workforce [in clinical nutrition] ..." | 2 |
a"Frequency of mention" refers to the number of focus groups, out of a total of four, in which the theme was mentioned.