Barber Sophy, Pavitt Sue, Meads David, Khambay Balvinder, Bekker Hilary
1 Orthodontic Department, Leeds Dental Institute, Clarendon Way, Leeds, UK.
2 Department of Translational and Applied Health Research, School of Dentistry, Professorial Suite, Clarendon Way, Leeds, UK.
J Orthod. 2019 Jun;46(2):126-136. doi: 10.1177/1465312519842743. Epub 2019 May 7.
To determine the extent to which the current care pathway in hypodontia promotes shared decision-making (SDM).
Exploratory cross-sectional study using qualitative methods.
Orthodontic department of two NHS teaching hospitals in Yorkshire.
Young people aged 12-16 years with hypodontia of any severity and at any stage of treatment, and their parents and guardians.
(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.
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.
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.
确定目前牙列缺损的护理路径在多大程度上促进了共同决策（SDM）。
采用定性方法的探索性横断面研究。
约克郡两家国民保健服务教学医院的正畸科。
年龄在12至16岁之间、患有任何严重程度牙列缺损且处于治疗任何阶段的年轻人及其父母和监护人。
（1）在无任何研究人员干预的情况下，对牙列缺损诊所的多学科会诊进行观察和录音（n = 5）；（2）使用主题指南对患有牙列缺损的年轻人（n = 8）及其父母（n = 8）进行简短的结构化访谈，以探讨围绕决策的主题。对录音进行转录并使用主题框架进行分析。
会诊被用作多学科讨论、提供信息和制定治疗计划的机会。观察到良好沟通的证据，但患者参与度较低。通常会说明要做出的决定并讨论治疗方案，但时间限制了充分信息交流和理解评估的范围。未采用任何方法来确定患者和家庭的偏好或价值观。访谈表明，父母期望牙科团队做出决策，而年轻人则依赖父母的支持。尽管几乎没有共同决策的证据，但参与者对他们的治疗表示满意。
目前牙列缺损的护理路径在共同决策步骤中无法为临床医生提供支持。改善共同决策过程的建议包括支持确定基于偏好的决策、更广泛地获取全面且易于理解的患者信息以便为会诊做准备、采用替代方法有效传达复杂信息以及使用偏好诱导工具辅助基于价值观的决策。
