Rationale and aims Shared decision-making is an approach whereby clinicians and patients make decisions together using the best available evidence. The most common cancers studied in relation to shared decision-making are breast and prostate. However, little is known about shared decision-making in patients with pancreatic cancer. We aimed to identify the determinants that influence pancreatic cancer patients in making treatment decisions during shared decision-making. Methods This qualitative study was carried out at a pancreatic outpatient clinic in an University Medical Center in the Netherlands. We reviewed the literature, observed patients in their option and decision talks, and interviewed healthcare professionals and patients. We used directed content analysis for the literature review, interview and observational data. To categorise the data, we used Bandura’s Social Cognitive theory. Results Related to Bandura’s categories, we identified six subcategories: information provided by healthcare professionals, the patient’s participation role, emotions due to the diagnosis, the relationship between the healthcare professional and the patient, patient characteristics and social support. The important determinants that influenced patients’ treatment decisions were a poor recall of information due to the emotions associated with diagnosis (e.g., completely shaken, fear) and the patient’s participation role preference (mostly collaborative). Most patients preferred to discuss their treatment options and the potential consequences for their daily life with healthcare professionals. In addition, the determinants ‘a well-informed patient’, ‘a trusting relationship between the healthcare professional and the patient’ and ‘time out’ were preconditions for enabling patients to take part in shared decision-making. Patient characteristics and social support had less of an influence on patient’s treatment decisions. Conclusions Better information recall, a trusting relationship with healthcare professionals, and a time out period for the consideration of treatment options are important determinants that influence patients in their treatment decisions and their preferred participation role during shared decision-making.

Introduction: To evaluate the long-term (5 years) effects of perioperative briefing and debriefing on team climate. We explored the barriers and facilitators of the performance of perioperative briefing and debriefing to explain its effects on team climate and to make recommendations for further improvement of surgical safety tools. Methods: A mixed-method evaluation study was carried out among surgical staff at a tertiary care university hospital with 593-bed capacity in the Netherlands. Thirteen surgical teams were included. Team climate inventory and a standardised evaluation questionnaire were used to measure team climate (primary outcome) and experiences with perioperative briefing and debriefing (secondary outcome), respectively. Thirteen surgical team members participated in a semi-structured interview to explore barriers and facilitators of the performance of perioperative briefing and debriefing. Results: The dimension ‘participative safety’ increased significantly 5 years after the implementation of perioperative briefing and debriefing (p = 0.02 (95% confidence interval 1.18–9.25)). Perioperative briefing and debriefing was considered a useful method for improving and sustaining participative safety and cooperation within surgical teams. The positive aspects of briefing were that shared agreements made at the start of the day and that briefing enabled participants to work as a team. Participants were less satisfied regarding debriefing, mostly due to the lack of a sense of urgency and a lack of a safe culture for feedback. Briefing and debriefing had less influence on efficiency. Conclusions: Although perioperative briefing and debriefing improves participative safety, the intervention will become more effective for maintaining team climate when teams are complete, irrelevant questions are substituted by customised ones and when there is a safer culture for feedback.