Behind another desk by Wilma Savelberg

For four years I combine my job as a communication advisor/health educator in the Maastricht UMC+ Oncologycenter with a job as a researcher in a PhD program on Shared Decision Making (SDM). As a health educator, with a background in nursing, a degree in health sciences, and an interest in the psychosocial aspects of oncology, I was always fascinated by the way patients participate in their own treatment. For instance, why did they agree on a treatment that would prolong their life by a few months, but the quality of life in these few months was expected almost to be zero. Was it because doctors give a highly optimistic view in contrast to reality or is longer lasting life far more important for patients than the consequences of treatment?

Searching for a new dimension in my work I had the chance to commit myself as a part time researcher to a Pink Ribbon project about SDM in women with early stage breast cancer. In this project I started with the development of a Patient Decision Aid which we tested in dedicated breast cancer teams in four different hospitals. My background in health education was very useful, as giving the right (amount of) information, at the right time is an important aspect of SDM. During the first year I also learned that SDM is much more than seeing that patients are well informed. I started to look different towards the consultations about treatment between clinicians and patient. As I talked to patients and professionals during my qualitative study, my insights on pathways, multi-disciplinary tumor boards and the support we offer, started to change. Based on my findings I plead to decide on treatment options instead of a treatment plan, to document these options in tumor board reports as well as in patient files, and to clarify the nurses role with regard to SDM in this process.

These apparently small changes seemed to trigger the clinicians to ask the patients different kind of questions with more focus on what the consequences of a treatment means in the daily life of patients. Although there is still room for improvement, SDM is increasingly becoming a routine practice in early stage breast cancer care. As an employee of the Oncologycenter I noticed the need to involve patients in their treatment decision with clinicians from different care teams. This led to a project in which I am helping to implement the lessons learnt from best practice early stage breast cancer, in four different teams.

With regard to the questions I asked myself in the first paragraph, I learned that there is not just one answer, so we need to deal with new challenges over and over again. For me, that is the beauty of combining the two different jobs. Learning from research and being able to apply it in practice almost at the same time. Actually, over the past years I felt that for me this was an ideal match.

Wilma Savelberg Health educator/Ph.D candicate
Wilma Savelberg