scholarly journals How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Bisphosphonate Therapy ◽  
Bone Block ◽  
Patient Anxiety ◽  
Patient Age ◽  
Endocarditis Prophylaxis ◽  
Therapy Decision ◽  
Patient Âgé ◽  
Case Vignettes

Abstract Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion “Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

scholarly journals How Do Specialist Surgeons Treat the Atrophic Tooth Gap? - A Vignette-based Study Among Maxillofacial and Oral Surgeons

2020 ◽  
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Bisphosphonate Therapy ◽  
Bone Block ◽  
Patient Anxiety ◽  
Patient Age ◽  
Endocarditis Prophylaxis ◽  
Therapy Decision ◽  
Patient Âgé ◽  
Case Vignettes

Abstract BackgroundThere is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons.MethodsA total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle.ResultsA total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision.Conclusion“Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

scholarly journals Decision-Making in Implantology—A Cross-Sectional Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

2021 ◽  
Vol 18 (4) ◽  
pp. 1596
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Cross Sectional Study ◽  
Bone Block ◽  
Bone Resection ◽  
Patient Age ◽  
Cross Sectional ◽  
Therapy Decision ◽  
Patient Âgé ◽  
Edentulous Mandible ◽  
Radiation Area

This cross-sectional study aimed to investigate the influence of possible factors in the patient history on decision making in the therapy for a severely atrophied edentulous mandible. A vignette-based survey among 250 maxillofacial and oral surgeons was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery, and radiotherapy in the head and neck area (the implant region is not in the direct radiation area). To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material, and bone resection. There also was the option of rejecting any therapy. The response rate was 47%. Patient age, radiotherapy, and fear of surgery did not influence the approval of a therapy. Smoking was associated with a significantly lower endorsement of a treatment. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. In summary, it can be said that, of the four determinants, only smoking influenced treatment refusal. Bone resection is the preferred therapy independent of all determinants.

The impact of patient age on clinical decision-making in oncology

2012 ◽  
Vol 3 ◽  
pp. S24-S25 ◽  
Author(s):  
J. Rule ◽  
M. Birtwistle ◽  
R. Day ◽  
J. Holding ◽  
A. Matarredona ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Age ◽  
Patient Âgé ◽  
The Impact

Discussing Adjuvant Cancer Therapy

2001 ◽  
Vol 19 (6) ◽  
pp. 1768-1778 ◽  
Author(s):  
Natasha Leighl ◽  
Melina Gattellari ◽  
Phyllis Butow ◽  
Richard Brown ◽  
Martin H.N. Tattersall
Keyword(s):  
Decision Making ◽  
Adjuvant Therapy ◽  
Patient Information ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Communication Patterns ◽  
Physician Communication ◽  
Patient Anxiety ◽  
Management Options ◽  
Information Recall

PURPOSE: To document the adequacy of patient information in oncology consultations concerning adjuvant therapy and explore predictors of physician communication patterns, treatment decisions, patient information recall, and satisfaction. PATIENTS AND METHODS: Retrospective analysis of audiotapes and verbatim transcripts of 101 initial adjuvant therapy consultations with medical and radiation oncologists was undertaken. Content analysis, data on communication patterns, treatment decisions, patient anxiety, satisfaction, and information recall were collected. Predictors of physician communication, treatment decisions, recall, and satisfaction with the consultation were identified. RESULTS: The majority of patients were well informed of their prognosis, benefits and risks of therapy, and alternative management options. Only half were asked about preferences for information or decision-making involvement. Predictors of information detail given include patient sex, age, occupation, and education. Radiation and medical oncologists express prognosis and treatment benefit using similar phrases. When offered the chance to delay decision-making, most patients do so (P < .01). Final treatment decisions appear to be influenced by the presentation of choice in treatment options by the oncologist and whether the treatment decision was made during the initial consultation (P < .01). Information recall was not influenced by communication factors. Patients receiving less detailed information had slightly higher satisfaction with the consultation (P = .03). More anxious patients tended to be less satisfied (P = .07). CONCLUSION: The optimal way to discuss adjuvant therapy is undefined. More emphasis can be placed on soliciting patient preferences for information and decision-making involvement and tailoring both to the needs of the individual patient. Providing choice in treatment and delaying decision-making may affect the patient’s treatment decision.

scholarly journals Frailty in Glioblastoma Is Independent From Chronological Age

2021 ◽  
Vol 12 ◽  
Author(s):  
Harald Krenzlin ◽  
Dragan Jankovic ◽  
Christoph Alberter ◽  
Darius Kalasauskas ◽  
Christiane Westphalen ◽  
...  
Keyword(s):  
Decision Making ◽  
At Risk ◽  
Overall Survival ◽  
Tumor Size ◽  
Geriatric Patients ◽  
Assessment Tool ◽  
Screening Tests ◽  
Chronological Age ◽  
Patient Age ◽  
Patient Âgé

Objective: Treatment of glioblastoma in elderly patients is particularly challenging due to their general condition and comorbidities. Treatment decisions are often based on chronological age. Frailty screening tests promise an assessment tool to stratify geriatric patients and identify those at risk for an unfavorable outcome. This study aims to evaluate the impact of age and frailty on the surgical outcome and overall survival in geriatric patients with glioblastoma.Methods: Data acquisition was conducted as a single-center retrospective analysis. From January 1st 2015, and December 31st 2019, 104 glioblastoma patients over 70 years of age were included in our study. Demographic data, tumor size, Karnofsky Performance Score (KPS), and Eastern Cooperative Oncology Group Performance Status (ECOG), as well as treatment modalities, were assessed. The Geriatric 8 health status screening tool (G8) and Groningen Frailty Index (GFI) were compiled pre-and postoperatively.Results: The mean patient age was 76.86 ± 4.11 years. Forty-nine (47%) patients were female, 55 (53%) male. Sixty-seven patients underwent microsurgical tumor resection, 37 received tumor biopsy alone. Mean G8 on admission was 12.4 ± 2.0, mean GFI 5.0 ± 2.5. In our cohort, frailty was independent of patient age, tumor size, or localization. Frailty, defined by G8 and GFI, is associated with shorter overall survival (G8: p = 0.0035; GFI: p = 0.0136) and higher numbers of surgical complications (G8: p = 0.0326; GFI: p = 0.0388). Frailer patients are more likely to receive best supportive care (p = 0.004). Nevertheless, frailty did not affect adjuvant treatment decision-making toward either single-use of chemo- or radiation therapy, stratified treatment, or concomitant therapy. The surgical decision on the extent of resection was not based on pre-operative frailty.Conclusion: In our study, frailty is a predictor of poorer surgical outcomes, post-operative complications, and impaired overall survival independent of chronological age. Frailty screening tests offer an additional assessment tool to stratify geriatric patients with glioblastoma and identify those at risk for a detrimental outcome and thus should be implemented in therapeutic decision making.

scholarly journals Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population

2021 ◽  
Vol 12 ◽  
pp. 215145932110030
Author(s):  
Madeline M. McGovern ◽  
Michael F. McTague ◽  
Erin Stevens ◽  
Juan Carlos Nunez Medina ◽  
Esteban Franco-Garcia ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Trauma Patient ◽  
Patient Population ◽  
Geriatric Patients ◽  
Proxy Consent ◽  
Health Care Proxy ◽  
Patient Age ◽  
Patient Âgé ◽  
Health Care Proxies

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy. Methods: Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form. Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent. Discussion: The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the consenting process. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients’ consenting capacity.

scholarly journals Decision-Making in Implantology – A Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

2020 ◽  
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Response Rate ◽  
Bone Block ◽  
Invasive Procedures ◽  
Bone Resection ◽  
Bone Substitute Material ◽  
Therapy Decision ◽  
Edentulous Mandible ◽  
Radiotherapy Treatment

Abstract BackgroundThe aim of the study was to investigate the influence of possible factors on decision making in the therapy for the severely atrophied edentulous mandible.MethodsA vignette-based survey among 250 maxillofacial surgeons and oral surgeons on the edentulous narrow atrophic mandible was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery and radiotherapy in the head and neck area. To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material and bone resection. In addition, there was the option of rejecting any therapy.ResultsThe response rate was 46.8%. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. Smoking led significantly more often to the rejection of an intervention. Fear of surgery had no influence on the treatment methods, previous radiotherapy treatment only for bone split.ConclusionsIn the narrow atrophic mandible, bone resection is the preferred therapy independent of all determinants. Surgeons tend to refrain from complex and invasive procedures in older patients and generally tend to refrain from interventions in smokers.

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