Department Child and Public Health, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.
Discipline of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Spec Care Dentist. 2022 Jan;42(1):20-27. doi: 10.1111/scd.12631. Epub 2021 Jul 13.
This paper explores the variables which influence decision-making processes in dentists providing dental care for people with disabilities under general anesthesia (GA).
Face-to-face semi-structured interviews were undertaken on a purposive sample. Audio recordings were transcribed and checked for accuracy. Using thematic content analysis methods open codes were developed inductively. Codes were analyzed further by three authors adopting a deductive approach, leading to final coding, sorting and themes, subtheme and framework development.
Three themes emerged. The first theme explored Shared Decision Making, or lack thereof, as it influenced clinical reasoning. The second (Systematic, Analytical) and third (Intuition, and heuristics) themes explored features of clinical judgment as considered under dual process theory. Dentists primarily used intuitive decision-making processes and heuristic styled processes (or cognitive mental frames) assisted in intuition to extract teeth, without engaging type 2 processes.
The dentists experience subtle modifiers to their decision-making that ultimately promote extraction of teeth under GA for people with disabilities. Bias training, simulation and post-hoc reflection are examples of recommendations which may be used to improve decision-making in this area.
本文探讨了影响为全麻下接受口腔护理的残疾患者提供口腔护理的牙医的决策过程的变量。
采用目的抽样法进行面对面半结构式访谈。对音频记录进行转录并检查准确性。使用主题内容分析方法，通过归纳法开发开放代码。通过三位作者采用演绎法进一步分析代码，最终得出编码、分类和主题、子主题和框架的发展。
出现了三个主题。第一个主题探讨了共享决策或缺乏共享决策如何影响临床推理。第二个（系统的、分析的）和第三个（直觉和启发式）主题探讨了双重加工理论下考虑的临床判断特征。牙医主要使用直觉决策过程和启发式过程（或认知心理框架）辅助直觉来拔牙，而不使用 2 型过程。
牙医在决策中会经历微妙的修饰，最终会促进为残疾患者在全麻下拔牙。偏见培训、模拟和事后反思是可用于改善该领域决策的建议的示例。
