Patient Preferred and Perceived Control in Dental Care Decision Making

et al. 2020

Preprint

Background: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.Methods: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n=100), a multiple sclerosis clinic (n=109), and a university-based prosthodontic clinic (n=100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p<.001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001).Conclusion: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

Section: Discussionsupporting

confidence: 91%

“…It could be argued that the role distributions as given in the ve CPS categories are distinctive qualities which hardly can be summarized, aggregated or correlated the way we did. However, several studies using the CPS considered the scale as quasi continuous and applied parametric statistical tests [23,25,26], as we did.…”

Section: Discussionmentioning

confidence: 99%

Patient autonomy in dentistry – demonstrating the role for shared decision making

et al. 2020

Preprint

“…Our ndings are in accordance with earlier studies on PAP in dentistry, indicating that the majority of patients prefer participating in the decision process, i.e. SDM [9,10,12,13,23]. Even though SDM was the preferred decision model amongst dental health patients in our study, there is still a marginal majority preferring a passive role.…”

Section: Discussionsupporting

confidence: 91%

“…It could be argued that the role distributions as given in the ve CPS categories are distinctive quality which hardly can summarized, aggregated or correlated the way we did. However, several studies using the CPS considered the scale as quasi continuous and applied parametric statistical tests [23,25,26], as we did.…”

Section: Discussionmentioning

confidence: 99%

Patient autonomy in dentistry – demonstrating the role for shared decision making

et al. 2020

Preprint

Background: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM). They are crucial in the process of decision making and can be incorporated into quality criteria which assess decision making in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.Methods: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n=100), a multiple sclerosis clinic (n=109), and a university-based prosthodontic clinic (n=100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p<.001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001).Conclusion: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general.

“…Our findings are in accordance with earlier studies on PAP in dentistry, indicating that the majority of patients prefer participating in the decision process, i.e. SDM [9,10,12,13,23]. Even though SDM was the preferred decision model amongst dental patients in our study, there is still a marginal majority preferring a passive role.…”

supporting

confidence: 91%

Patient autonomy in dentistry: demonstrating the role for shared decision making

BMC Med Inform Decis Mak

et al. 2020

Background Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings. Methods A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n = 100), a multiple sclerosis clinic (n = 109), and a university-based prosthodontic clinic (n = 100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p = .035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p < .001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p < .001). Conclusion There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.