Presenting information on dental risk: PREFER study protocol for a randomised controlled trial involving patients receiving a dental check-up

Abstract

IntroductionA new dental contract being tested in England places patients into traffic light categories according to risk (Red = High risk). This reflects health policy which emphasises patients' shared responsibility for their health, and a growing expectation that clinicians discuss health risk in consultations. Alongside this, there are technological developments such as scans and photographs which have generated new, vivid imagery which may be used to communicate risk information to patients. However, there is little evidence as to whether the form in which risk information is given is important.MethodsThe PREFER study is a pragmatic, multi-centre, three-arm, patient-level randomised controlled trial, based in four NHS dental practices, from which 400 high/medium risk patients will be recruited. The study compares three ways of communicating risk information at dental check-ups: 1) verbal only (usual care); 2) a Traffic Light graphic with verbal explanation; 3) a Quantitative Light-Induced Fluorescence (QLF) photograph showing, for example, patches of red fluorescence where dental plaque has been present for two days or more (with a verbal explanation). The study assesses patient preferences using the economic preference-based valuation methodology Willingness-to-Pay (WTP). Any changes in oral self-care (for example in tooth-brushing), will be measured by self-report, and clinical outcome data collected by clinicians and extracted from QLF photographs. Predictors and moderators of any behaviour change will be explored using demographic characteristics and psychological variables from the Extended Parallel Process Model. A cost-benefit framework will explore the financial implications for NHS dentistry of the three risk presentation methods.

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

“…Ethical approval was obtained (number 14/NW/1016). A full description of trial processes has been published in a protocol [12]. The trial aim was to compare how dental patients’ value and respond to information on risk in three ways: usual verbal advice (V); V supported by information on their TL rating; and V supported by a QLF photograph.…”

“…Inclusion criteria were: adults (aged 18+ years) with at least some teeth, identified as Red or Amber risk for poor oral health using the TL algorithm being piloted elsewhere in NHS practices [2, 12]. Exclusion criteria were: patients identified as ‘Green’ (low risk); patients attending for an emergency appointment (because a full check-up and risk assessment is not usual care); and patients with low English language ability who required an interpreter for appointments [12]. Patients were approached to take part by trained dental staff when making an appointment for an NHS dental check-up.…”

“…They were then presented with a series of virtual cards with different values from 50 pence to £150 (randomly ordered) and asked to drag these into one of three boxes: Would pay/Wouldn’t pay/Not sure (the shuffled card method). Collection of WTP data also used an incremental approach and follow-up questions to discriminate between protest zeros (unwillingness to engage in the task) and true zeros (value rated as 0) [12, 16]. WTP was elicited first for the least preferred intervention and then the extra WTP for the next preferred was elicited followed by the extra WTP for the most preferred (i.e.…”

“…These included the literacy measure Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) [19]. A full description of measures used for predictor variables is available [12].…”

Risk work in dental practices: an ethnographic study of how risk is managed in NHS dental appointments

“…This paper comprises one arm of a wider study that aimed to explore risk communication preferences in dental settings (Harris et al . 2018). This part of the study aimed to explore what currently happens in routine dental practice, with a focus on ‘risk work’.…”