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.

When attitudes and beliefs get in the way of shared decision-making: A mediation analysis of participation preference

INTRODUCTION

Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making.

METHODS

We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model.

RESULTS

We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients.

CONCLUSION

Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM.

PATIENT OR PUBLIC CONTRIBUTION

This study was part of a larger project on implementing SDM in urological practice. Several stakeholders were involved in the design, planning and conduction of this study, for example, three authors are practising urologists, and three are psychologists with experience in patient care. In addition, the survey was piloted with patients, and their feedback was integrated into the questionnaire. The data presented in this study is based on patients' responses. Results may help to empower our patients.

Dentists' attitudes toward patient-centered care and its predictors: a cross-sectional study in South Korea

BACKGROUND

Patient-centered care (PCC) has been one of medical practice's most frequently discussed principles. However, attitudes toward PCC among dentists remain underexplored. This study focuses on examining dentists' patient-centered attitudes and investigating their predictors.

METHODS

The Patient-Practitioner Orientation Scale which consists of Sharing and Caring subscales was used to assess patient-centered attitudes. The statistical analysis included 217 dentists from South Korea. Hierarchical linear regression analysis was performed to examine the predictors such as sociodemographic aspects, academic factors, work-related factors, and empathy.

RESULTS

A patient-centered attitude of Caring subscale (M = 4.29, SD = 0.56) emerged, but the provider-centered attitude was higher in Sharing subscale (M = 3.40, SD = 0.48). Work year, academic track, and empathy were associated significantly with an overall caring aspect of patient-centered attitude, while the gender effect remained insignificant. Empathy had a critical and significant impact on the patient-centered attitude.

CONCLUSIONS

Efforts to enhance patient-centeredness in Sharing are needed; post-graduate education and transition to a more patient-centered health system are recommended. Moreover, empathy still matters as it was found to be a significant predictor of patient-centered attitudes. The findings of this study support the need for efforts to enhance patient-centered attitudes among dentists, which will help generate discussion on improving the curriculum of post-graduate education and health system reform.

Women's view on shared decision making and autonomy in childbirth: cohort study of Belgian women

Background

Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman’s birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population.

Methods

This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM–Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium).

Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making.

Results

In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001).

Conclusions

Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.

Factors influencing autonomy supportive consultation: A realist review

OBJECTIVE

Gaining insight into contextual factors and mechanisms supporting or hindering autonomy supportive consultation and into outcomes of such consultations.

METHODS

We conducted a systematic review using the realist synthesis procedure according to RAMESES guideline. A search was performed in PubMed, Embase, PsycINFO and Cinahl from inception to March 2019 using the search terms: 'autonomy' AND 'support' AND 'consultation' OR 'communication' AND 'intervention'. The review process including paper selection, quality assessment, full text reading for data-extraction was conducted by two researchers independently.

RESULTS

Of 2792 articles, 18 met our inclusion criteria. Contextual factors influencing an autonomy supportive consultation were: work organization and the attitude of professionals. An overarching supporting mechanism for AS was relationship building. In addition, each phase of the decision-making process seems to need supporting mechanisms fulfilling patients 'specific psychological needs in that phase. The outcome of AS is higher levels of patient well-being.

CONCLUSION

Autonomy supportive consultation works under various contexts coupled with mechanisms that give rise to favourable-outcomes, of which relationship building, taking time and exploring patients' needs seem the most important.

PRACTICE IMPLICATIONS

The results of our review facilitate professionals to reflect on their autonomy supportive consultation skills, which could improve their autonomy supportive behaviour.

Factors Affecting Satisfaction with the Process of Orthodontic Treatment in Young Adults: A Questionnaire Study

Introduction: Recently, there has been an increase in adults undergoing orthodontic treatment in both the public and the private sector. Satisfaction during and after the orthodontic treatment process has not been widely discussed so far, however, and few research studies have emphasized patient satisfaction with treatment outcome and the factors affecting patient satisfaction.

Aim: To investigate factors affecting patient satisfaction with the process of orthodontic treatment in young adults.

Material and methods: Fifty-eight patients (33 girls and 25 boys with a mean age of 25.05 years, SD 2.83) were included in the survey. All patients were young adults who had completed their orthodontic treatment with fixed appliances and were taken from two centers (a teaching hospital and a private practice). Data was collected using online survey forms and was analyzed using content thematic analysis. Five main factors were identified related to patient satisfaction with the process of orthodontic treatment: communication, faculty (orthodontist), physical surroundings, consultation/appointments, and impact of appliance treatment.

Results: Effective communication was the most prominent factor among all five factors considered, especially detailed explanation given during treatment and making patients feel comfortable under their care. Median values were generally high for satisfaction with treatment results. There was a clear correlation ( p < 0.001) between patient satisfaction and treatment outcome. Age, sex and treatment time did not have any correlation with treatment satisfaction.

Conclusion: In general, young adults were observed to be satisfied with the treatment process, and good communication played a dominant role in this. Though there were many differences in working models between public and private sectors, many similarities were observed when comparing the factors between the two centers.

Shared decision-making (SDM) in dentistry: A concise narrative review

OBJECTIVE

The aim of this review was to evaluate the implementation of shared decision-making (SDM) in dentistry and the roles of informed consent and patient decision-making aids (PDAs) as part of this process.

MATERIALS AND METHODS

A review of pertinent literature was performed using PubMed and MEDLINE to determine the current position of the application of SDM in dentistry and the influence of informed consent and PDAs on this process.

RESULTS

Limited number of published studies on the implementation of SDM in dental practice is available. These studies demonstrated that SDM is influenced by many factors. Informed consent intertwines with the SDM process and begins with providing high quality information to patients and employing PDAs. PDAs have been developed for some dental fields to facilitate the SDM process.

CONCLUSIONS

SDM is applied in dentistry and is influenced by many factors. Informed consent is an important part of this process. PDAs in more dental fields need to be further developed, in order to ensure a satisfactory integration of patients in the SDM process.

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.

Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study

INTRODUCTION

For effective risk communication, clinicians must understand patients' values and beliefs in relation to the risks of treatment. This qualitative study aimed to explore adolescent perceptions of orthodontic treatment risks and risk information.

METHODS

Five focus groups were carried out with 32 school/college pupils aged 12-18 in Wales, UK. Participants were purposively selected and had all experienced orthodontic treatment. A thematic approach was used for analysis and data collection was completed at the point of data saturation.

RESULTS

Four themes emerged from the data; (a) day-to-day risks of orthodontic treatment, (b) important orthodontic risk information, (c) engaging with orthodontic risk information and (d) managing the risks of orthodontic treatment. Day-to-day risks of orthodontic treatment that were affecting participants "here and now" were of most concern. Information about preventing the risks of treatment was deemed to be important. Participants did not actively seek risk information but engaged passively with information from convenient sources. Perceptions of risk susceptibility influenced participants' management of the risks of orthodontic treatment.

CONCLUSIONS

This study demonstrates that adolescent patients can understand information about the nature and severity of orthodontic treatment risks. However, adolescent patients can have false perceptions if the risks are unfamiliar, perceived only to have a future impact or if seen as easy to control. Adolescent patients must be provided with timely and easily accessible risk information and with practical solutions to prevent the risks of treatment.

CLINICAL SIGNIFICANCE

The views and experiences gathered in this study can assist clinicians to better understand their young patients' beliefs about treatment risks, facilitate effective risk communication and contribute to improved patient-centred care.

Assessment of information resources for people with hypodontia

Aim:

To assess the adequacy of patient information to support understanding and decision-making for people affected by hypodontia.

Methods:

1) Questionnaire to understand the provision of patient information by dentists; 2) Systematic search to identify online open-access patient information; 3) Quality assessment of written patient information.

Results:

Questionnaire response rate was 49% (319/649); 91% examined and/or treated people with hypodontia. Most general dentists referred patients to specialist services without providing written hypodontia information. The majority of dental specialists provide patient leaflets but less than a third used web-resources. Only 19% of respondents felt current resources were fit-for-purpose. Thirty-one patient resources (18 leaflets and 13 online) were assessed against quality criteria. The aim of the resource was seldom explicit, the content was often incomplete and variation in readability scores indicated high levels of literacy were required.

Discussion:

Access to, and quality of, patient information for hypodontia is inadequate. Current resources are not sufficiently comprehensive to prepare young patients to engage in shared dental care decisions with their parents and/or dental professionals.

Conclusion:

There is a need for improved access to, and provision of, information about hypodontia if dental professionals want to meet best practice guidance and involve patients in shared decision-making.

Impact of patient information leaflets on pain medication intake behavior: a pilot study

Negative wording in package information leaflets of pain medication is associated with a tendency to evoke negative emotions and lower willing to take medication.

Introduction:

Patient information leaflets on pain medication primarily list side effects while positive effects and action mechanisms remain underrepresented. Nocebo research has shown that negative instructions can lower analgesic effects.

Objectives:

Research on information leaflets and their influence on mood, memory of side effects, and intake behavior of healthy participants is needed.

Methods:

To determine the ratio of positive to negative phrases, 18 information leaflets of common, over-the-market analgesics were examined of which 1 was selected. In a randomized, controlled study design, 18 healthy participants read this leaflet while 18 control group participants read a matched, neutral leaflet of an electrical device. Collected data concerned the recall of positive and negative contents, mood, anxiety, and the willingness to buy and take the drug.

Results:

All examined leaflets listed significantly more side effects than positive effects (t₁₇ = 5.82, P < 0.01). After reading the analgesic leaflet, participants showed a trend towards more negative mood (F_1,34 = 3.78, P = 0.06, η_p² = 0.1), a lower intention to buy [χ² (1, n = 36) = 12.5, P < 0.01], a higher unwillingness to take the medication [χ² (1, n = 36) = 7.2, P < 0.01], and even a greater recall for side effects than positive effects (t₁₇ = 7.47, P < 0.01).

Conclusion:

Reading the patient information leaflets can increase fear and lower the intention to buy and the willingness to take a pain medication.

Dento-legal considerations about an MI approach

Over the years there have been many conceptual changes in how dental disease is prevented and managed. What is now the norm and standard practice was at some earlier time considered to be at best pioneering, and at its worst, heresy or negligent. When we look, for example at how we conservatively manage periodontal disease when less than a generation ago we were wielding surgical knives far more frequently than we do now, we can see how research and evidence-based dentistry has influenced our thinking. We are very much at that tipping point now with minimum intervention (MI) dentistry. This article will discuss the impact of MI dentistry from a legal viewpoint, covering such aspects as consent and record-keeping.