Perceptions and attitudes of patients towards medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in England

Abstract

ObjectiveTo explore the impact of medication-related osteonecrosis of the jaw (MRONJ) on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the prevention of the condition.DesignInterpretivist methodology using qualitative semistructured interviews.SettingPrimary care general medical practices and secondary care dental services in England.Participants23 patients; 6 with MRONJ, 13 prescribed bisphosphonates, 4 with osteoporosis not currently prescribed any medication.ResultsPatients felt that MRONJ had a significant negative impact on their quality of life and had poor knowledge of the preventive strategies recommended in the literature. Patients demonstrated positive attitudes towards a multidisciplinary approach to care; however, they perceived prescribers as having the key role in articulating risk. Four salient and inter-related themes emerged from the interviews: (1) perception of knowledge, indicating limited awareness of the condition, risk factors and preventive strategies; (2) quality of life, indicating the lived experiences of patients and the physical, psychological and social impacts of MRONJ; (3) interprofessional management, indicating a perceived organisational hierarchy, professional roles and responsibilities, prioritising aspects of care, articulation of risk and communication and (4) wider context, indicating demands on National Health Service resources and barriers to dental care.ConclusionsMRONJ has a significant detrimental impact on quality of life, yet appropriate preventative education is not apparent. Effective interprofessional patient education and prevention to mitigate against the risk of developing MRONJ is required.

Knowledge, attitude, and management of general dentist toward medication-related osteonecrosis of the jaws

“…Some studies have also insisted on effective professional patient education and prevention of developing MRONJ. [ 16 ]…”

Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals

“…Barriers to successful MRONJ prevention can include poor patient knowledge or understanding of the recommended preventative strategies [42], which can be addressed by education. In a qualitative study of 23 patients with MRONJ, fear of visiting the dentist, lack of awareness of the importance of oral health, and cost of dental treatment were all identified as potential barriers to MRONJ prevention [42]. Oral health disparities, such as access to oral healthcare, the patient's socioeconomic status, and health literacy, are also noted as barriers in the MASCC/ISOO/ASCO Clinical Practice Guideline [2].…”

‘We do not seem to engage with dentists’: a qualitative study of primary healthcare staff and patients in the North East of England on the role of pharmacists in oral healthcare

“…Medication-related osteonecrosis of the jaw (MRONJ) is a rare, yet significant complication of antiresorptive and antiangiogenic drugs used in the treatment of osteoporosis and cancer 18. MRONJ is difficult to treat and significantly impacts on patient’s quality of life19; therefore a multidisciplinary approach to prevention is usually recommended 18…”