Assessment of information resources for people with hypodontia

Involving young people and parents in decision-making for hypodontia

Involving young people and their parents in decisions about their health care is ethically and professionally the right thing to do. Good decision-making relies on informed, value-based deliberation. Providing the right treatment for people with hypodontia is complex, both technically, in terms of the range of options available, and from a communication perspective. Treatment decisions faced by young people with hypodontia can have lifelong implications and the weight of this is felt both by the patient, who may have limited experience of dental treatment and decision-making, and their parents, who act as advocates. It is important that clinicians understand how they can best share the available evidence and their expertise in a way that can be understood and applied. Clinicians also have an important role in facilitating young people to recognise and communicate their own values, expectations, and ultimately, preferences for treatment. This paper outlines the challenges of navigating information sharing and engaging in shared decision-making specific to hypodontia. A scoping review of the literature by the authors was conducted to identify evidence-based advice for discussing uncertainties, risks and increasing engagement in decision-making. This may be useful to both primary and secondary care practitioners involved in decision-making with people with hypodontia.

The quality and reliability of the Internet as a source of information for hypodontia patients

OBJECTIVES

The aim of this study was to determine the quality, reliability and usability of information on the Internet regarding hypodontia.

METHOD

A survey of patients with hypodontia revealed seven key search terms favoured by patients: Hypodontia; Congenitally missing teeth; Missing teeth; Gaps in teeth; Cure of missing teeth; Information on missing teeth; and Treatment of missing teeth. These were entered into four search engines: Google; Ask; Wikipedia; and NHS Choices. Relevant websites were assessed for their overall demographics, author type, country of origin and rank within the search engine. They were then analysed using five validated assessment tools. Intra-examiner reliability was assessed, and statistical analysis of the data was undertaken.

RESULTS

Good intra-examiner reliability was observed. A total of 48 websites were included for analysis from an initial 1718. There was no relationship between the ranking of a website on a search engine and the quality of information it contained. When medical search terminology was used, it resulted in websites of better quality than layperson search terms. Most websites were produced by general dental or specialist dental practices but the quality of these was poorer than those developed by private companies and medical organisations. The country of origin was primarily the USA and UK; however, this had no relationship to website quality. Overall, the majority of websites scored poorly for the validated tools and none scored well across multiple tools. A statistical analysis showed a positive relationship between the LIDA and DISCERN instruments but no other correlation between other validated tools was found.

CONCLUSION

The quality and reliability of information on the Internet regarding hypodontia is generally poor. There is a need for a reliable online hypodontia resource that can be recommended for patient use.

Laypeople's interpretation of, and preference for, orthodontic images

Background:

Good communication is fundamental to provision of information and patient engagement in orthodontic treatment. Images can be used to support verbal and written information, but little is known about how laypeople interpret orthodontic images.

Objective:

To explore laypeople’s understanding and preferences for images (clinical photographs and medical illustrations) relating to orthodontic diagnoses and treatments.

Design:

Cross-sectional survey.

Setting:

UK.

Population:

Laypeople aged ⩾16 years.

Methods:

Participants were recruited through social media to complete an online questionnaire containing six pairs of images (clinical photograph and medical illustration) relating to orthodontic diagnoses and treatment. Photographs were selected from a bank with input from laypeople, then a matching medical illustration was created. Images were presented with questions relating to interpretation, preferences and reasons for preferences.

Results:

A total of 898 people completed the questionnaire. Interpretation of images by laypeople was variable and, in some cases, normal intra-oral features and image orientation caused confusion. A combination of photograph and illustration were preferred for images representing diagnosis (by 41%–50% participants), whereas the illustration alone or both photograph and illustration together was preferred for explaining treatment (43%–48% and 35%–44%, respectively). Photographs were liked for their realism and relatability, while illustrations were often found to be clearer. Arrows aided participants’ understanding of the images, but annotations were requested to further improve the value of images. Only 26% of participants reported having previously been shown dental images, but 96% felt they would be helpful to support verbal and written information.

Conclusion:

Laypeople may not interpret orthodontic images in the way that professionals expect, and unfamiliar intra-oral features may distract people from the intended focus of the image. A combination of photographs and illustrations together may improve the usefulness of images, alongside annotation or explanation.

The reach, influence and tenor of professional orthodontic societies on social media: A cross-sectional content analysis

BACKGROUND AND OBJECTIVES

Orthodontic societies should support the profession and improve patient awareness. We aimed to investigate the scope and influence of orthodontic societies on social media.

METHOD

A total of 120 orthodontic societies were identified on the World Federation of Orthodontists (WFO) affiliates list. Presence of orthodontic societies on Instagram, Facebook and Twitter was ascertained. All societies with Instagram accounts were included for further analysis of the nature and content of posts as well as user engagement. Pilot coding and thematic analysis were undertaken (n=200 posts). The most recent 20% of the total number of posts for each account were then analysed for content.

RESULTS

Only 10 (8.3%), 34 (28.3%) and 52 (43.3%) orthodontic societies had accounts on Twitter, Instagram and Facebook, respectively. A total of 2124 Instagram posts were analysed. On average, 318 posts were identified per account (range=1 to 1901). The average number of followers was 2337 (range=85 to 11,400) with average user engagement of 1.25% (range=0.0%-7.17%). A total of 6 themes (subthemes; n=28) were identified including "announcements on professional events" (51.6%), "patient education, enlightenment and commendation" (26%), "running and operation of the society" (9.1%), "highlighting research and evidence" (3.1%), "COVID-related advice and updates" (4%) and "observance and commemoration" (10.4%). The posts targeting patients were limited (18.7%).

CONCLUSIONS

The limited reach of the accounts of international orthodontic societies highlights the need to develop a more effective and influential social media presence. Orthodontic societies should involve members, providers and patients in developing more effective social media resources.

Development of a Discrete-Choice Experiment (DCE) to Elicit Adolescent and Parent Preferences for Hypodontia Treatment

Objective

Our objective was to develop and test a discrete-choice experiment (DCE) survey to elicit adolescent and parent preferences for dental care for hypodontia (a developmental condition where one or more teeth fail to develop).

Methods

This was a mixed-methods study. Participants were adolescents (aged 12–16 years) with hypodontia and their parents and the dentists providing hypodontia care. Stage one entailed attribute development, as follows. (1) Attribute identification: systematic review of hypodontia literature; interviews with adolescents with hypodontia (n = 8) and parents (n = 8); observation of hypodontia clinical consultations (n = 5); environmental scan of hypodontia patient information resources (n = 30); and systematic analysis of social media posts (n = 176). (2) Attribute selection: stakeholder consultation to develop items for a questionnaire; rating and ranking questionnaire for adolescents with hypodontia and parents (n = 18); further stakeholder consultation. Stage two involved the development of the DCE survey, and stage three included the pre-testing using cognitive interviews with adolescents (n = 12) and parents (n = 8) to assess face and content validity.

Results

The attribute long list included 27 attributes focusing on service delivery and treatment outcome, from which seven ‘important’ attributes were selected for pre-testing. Cognitive interviewing suggested adolescents found the DCE choice tasks challenging to understand; the survey was modified to enhance its acceptability. One attribute was excluded as it showed poor validity with adolescents. Pre-testing suggested DCE choice tasks encouraged thinking and discussion about preferences for treatment.

Conclusions

Including the target respondent group in all stages of DCE development ensured the final DCE survey was valid and acceptable. DCE methods appear to be a useful tool for exploring joint decision making alongside conventional preference elicitation.

Electronic supplementary material

The online version of this article (10.1007/s40271-018-0338-0) contains supplementary material, which is available to authorized users.

Can the current hypodontia care pathway promote shared decision-making?

OBJECTIVE

To determine the extent to which the current care pathway in hypodontia promotes shared decision-making (SDM).

DESIGN

Exploratory cross-sectional study using qualitative methods.

SETTING

Orthodontic department of two NHS teaching hospitals in Yorkshire.

PARTICIPANTS

Young people aged 12-16 years with hypodontia of any severity and at any stage of treatment, and their parents and guardians.

METHODS

(1) Observation and audio-recording of interdisciplinary consultation in hypodontia clinics (n = 5) without any researcher interference; (2) short, structured interviews with young people with hypodontia (n = 8) and their parent (n = 8) using a topic guide to explore themes around decision-making. Audio-recordings were transcribed and analysed using a thematic framework.

RESULTS

Consultations were used as an opportunity for interdisciplinary discussion, information provision and treatment planning. Evidence of good communication was observed but patient engagement was low. The decision to be made was usually stated and treatment options discussed, but time constraints limited the scope for adequate information exchange and assessment of understanding. No methods were used to establish patient and family preferences or values. Interviews suggested parents expect the dental team to make decisions and young people rely on parental advocacy. Despite little evidence of SDM, participants reported satisfaction with their treatment.

CONCLUSIONS

The current care pathway for hypodontia does not support clinicians in the steps of SDM. Recommendations for improving SDM processes include support to identify preference-based decisions, greater access to comprehensive and accessible patient information to enable preparation for consultation, alternative methods for effective communication of complex information and use of preference elicitation tools to aid value-driven decision-making.

More patient-centred measures required to evaluate hypodontia care outcomes and drive health service improvements

Data sourcesPubMed, Medline via Ovid (1946 onward), EMBASE via Ovid (1947 onward), Scopus, Web of Science (Scientific Citation Index, Conference Indexes), dissertations and theses databases; Cochrane Collaboration (DARE, CDSR), NICE, SIGN, ClinicalTrials.gov; grey literature searching.Study selectionSix electronic databases were searched for terms related to hypodontia and treatment methods, and four further electronic databases searched using terms for hypodontia only. Mixed-method study designs were used with exclusion of case reports, case series with fewer than ten participants and nonsystematic reviews. Quality improvement reports were also included and managed separately. No language restrictions were used.Data extraction and synthesisData from each study were systematically extracted using a data extraction form modified from the Cochrane Public Health Group template. One reviewer completed data extraction, with a second reviewer checking for accuracy and consistency. Four outcome categories were developed to synthesise the studies using a novel categorisation approach based on the perspective of the study's evaluator; including three subjective outcomes (patient-reported, clinician-reported and lay-reported) and one objective outcome (clinical indicators). No synthesis of efficacy data was planned; therefore, a methodologic quality appraisal of studies was not undertaken.ResultsThe search identified 497 abstracts, from which 106 eligible articles were retrieved in full. Fifty-six studies and eight quality-improvement reports were included. Clinical indicators were reported in 49 studies (88%) including appearance, function, dental health, treatment longevity, treatment success and service delivery. Patient-reported outcomes were given in 22 studies (39%) including oral health-related quality of life, appearance, function, symptoms of temporomandibular dysfunction and patient experience. Clinician-reported and lay-reported outcomes were limited to appearance. Variability was seen in the tools used for measuring outcomes.ConclusionsThere is a lack of rationale and consistency in the selection of outcome measures used to evaluate hypodontia care. Outcomes are largely clinician and researcher-driven with little evidence of their relevance to patients. Evidence from hypodontia research is clinician-focused and likely to have limited value to support patients during decision-making. There is a need for a core-outcomes set with a patient-centric approach to drive improvements in health services.