Patient autonomy in dental medical decision making – is there a need for shared decision making?

Abstract Background: Evidence-based Dentistry (EBD), decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM) and are useful tools in the process of medical and dental decisions as well as in developing of quality criteria for decision making in many fields of health care. However, there aren’t many studies on SDM and AP in the field of dentistry. This study aimed at exploring patients’ autonomy preferences in dentistry in comparison to other medical domains. Methods: As a first step, a consecutive sample of 100 dental patients and 16 dentists was recruited at a university-based prosthodontic clinic to assess and compare patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions using the Control Preference Scale (CPS). This was followed by a cross sectional survey to study autonomy preferences in three cohorts of 100 patients each recruited from general practices, a multiple sclerosis clinic, and a university-based prosthodontic clinic. A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in this process. Results: Dentists were slightly less willing to deliver control than patients willing to enact autonomy. Decisions about management of tooth loss were however considered relevant for a shared decision making by both parties. Highest AP was expressed by people with multiple sclerosis, lowest by patients in dentistry (CPS means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). Patients analysis showed considerable differences in autonomy preferences referring to different decision types (p<.001). More autonomy was needed for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001). Conclusion: The study results showed substantial relevance of patient participation in decision making in dentistry. Furthermore, a need has been discovered to refer to specific medical decisions instead of assessing autonomy preferences in general.

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Patient autonomy in dental medical decision making – demonstrating the need for shared decision making

10.21203/rs.2.17746/v2 ◽

2020 ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel Reissmann

Keyword(s):

Multiple Sclerosis ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Treatment Decisions ◽

Medical Decision ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Study Results

Abstract Background: Evidence-based Dentistry (EBD), decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM) and are useful tools in the process of medical and dental decisions as well as in developing of quality criteria for decision making in many fields of health care. However, there aren’t many studies on SDM and AP in the field of dentistry. This study aimed at exploring patients’ autonomy preferences in dentistry in comparison to other medical domains. Methods: As a first step, a consecutive sample of 100 dental patients and 16 dentists was recruited at a university-based prosthodontic clinic to assess and compare patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions using the Control Preference Scale (CPS). This was followed by a cross sectional survey to study autonomy preferences in three cohorts of 100 patients each recruited from general practices, a multiple sclerosis clinic, and a university-based prosthodontic clinic . A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in this process. Results: Dentists were slightly less willing to deliver control than patients willing to enact autonomy. Decisions about management of tooth loss were however considered relevant for a shared decision making by both parties. Highest AP was expressed by people with multiple sclerosis, lowest by patients in dentistry (CPS means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). Patients analysis showed considerable differences in autonomy preferences referring to different decision types (p<.001). More autonomy was needed for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001). Conclusion: The study results showed substantial relevance of patient participation in decision making in dentistry. Furthermore, a need has been discovered to refer to specific medical decisions instead of assessing autonomy preferences in general.

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Patient autonomy in dentistry – demonstrating the role for shared decision making

10.21203/rs.2.17746/v3 ◽

2020 ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel Reissmann

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Patient Preferences ◽

Quality Criteria ◽

Treatment Decisions ◽

Shared Decision ◽

Cross Sectional

Abstract Background: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM). They are crucial in the process of decision making and can be incorporated into quality criteria which assess decision making in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.Methods: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n=100), a multiple sclerosis clinic (n=109), and a university-based prosthodontic clinic (n=100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p<.001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001).Conclusion: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general.

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Patient autonomy in dentistry – demonstrating the role for shared decision making

10.21203/rs.2.17746/v4 ◽

2020 ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel R. Reissmann

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Patient Preferences ◽

Health Care Professionals ◽

Skills Training ◽

Treatment Decisions ◽

Shared Decision

Abstract Background: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.Methods: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n=100), a multiple sclerosis clinic (n=109), and a university-based prosthodontic clinic (n=100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p<.001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001).Conclusion: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

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Patient autonomy in dentistry: demonstrating the role for shared decision making

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01317-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel R. Reissmann

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Patient Preferences ◽

Health Care Professionals ◽

Skills Training ◽

Treatment Decisions ◽

Shared Decision

Abstract Background Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings. Methods A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n = 100), a multiple sclerosis clinic (n = 109), and a university-based prosthodontic clinic (n = 100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p = .035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p < .001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p < .001). Conclusion There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

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Treatment Decision Needs of Psoriasis Patients: Cross-sectional Survey

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2010.09049 ◽

2010 ◽

Vol 14 (5) ◽

pp. 233-239 ◽

Cited By ~ 15

Author(s):

Jerry Tan ◽

Dawn Stacey ◽

Karen Fung ◽

Benjamin Barankin ◽

Robert Bissonnette ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Online Survey ◽

Treatment Decision ◽

Treatment Decisions ◽

Shared Decision ◽

Medical Evidence ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Values

Background: Informed shared decision making is a mutual process engaging both doctor and patient and informed by best medical evidence and patient values and preferences. Objective: Our aim was to identify the needs of psoriasis patients in decisions on selecting treatment. Methods: Psoriasis subjects participated in an online survey on decisional role, postdecisional conflict, and treatment awareness. Results: Of 2,622 people invited to participate, 248 completed surveys. Their most recent treatment decision was either made by subjects alone (42%) or physicians alone (28%) or was shared (29%). Subjects perceived that their doctors lacked time to stay abreast of treatments, to provide counseling, and to access appropriate treatments. Deficiencies most frequently identified were information on options, clarification of values, access to physicians, and decision-making skills. Those with a body surface area (BSA) ≥ 3% more frequently indicated that having the skill or ability to make treatment decisions was important. Limitations: The limitations of this study include sampling, recall, and reporting bias. Percent BSA was not verified. Conclusions: The multiple deficiencies in support of psoriasis patients in treatment decisions may preclude informed shared decision making.

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Shared decision making in radiation oncology: Implications for patient satisfaction.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6610 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6610-6610

Author(s):

Jacob Ezra Shabason ◽

Jun J Mao ◽

Eitan S. Frankel ◽

Neha Vapiwala

Keyword(s):

Decision Making ◽

Patient Satisfaction ◽

Shared Decision Making ◽

Radiation Oncology ◽

Treatment Decisions ◽

Cancer Center ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Targeted Interventions

6610 Background: Shared decision making (SDM) has been linked to healthcare quality outcomes, including patient satisfaction. However, the importance of SDM has not been evaluated in radiation oncology. This study aims to determine the association between patient-perceived SDM and patient satisfaction during radiation therapy (RT). We also explore patient desire for and perception of control during RT and its relationship to patient satisfaction. Methods: We conducted a cross-sectional survey of 305 patients undergoing RT at an urban academic cancer center. Patients self-reported measures of satisfaction and control during the last week of RT. SDM was measured using a 3-item validated instrument. The relationships between SDM, control over treatment decisions, and satisfaction were evaluated using chi-2 analyses. Results: The 305 participants had a mean age of 59.8 (range 18-87) and were 47.5% female. Ethnicities included white (75.7%), black (19.7%), Asian (2.6%), and Hispanic (0.7%). Tumor types represented were breast (19.7%), prostate (17.7%), head and neck (18%), gastrointestinal (15.1%), lung (13.4%), and other cancers (16.1%). Ninety (31.3%) patients reported experiencing SDM and 227 (76.2%) reported feeling very satisfied with their treatments. There were no significant differences in these outcomes based on demographic or clinical characteristics. Patients who experienced SDM were more likely to be satisfied with the care provided by their radiation oncologist (84.4% vs. 71.4%, p <0.02). Furthermore, the perception of having control in treatment decisions was associated with increased satisfaction regardless of whether the patient preferred control or not (Table). Conclusions: These findings emphasize the value of SDM in radiation oncology. Regardless of a patient's desire for control, it is important for physicians to engage patients in the decision making process. Both physician- and patient-targeted interventions may aid in improving SDM and, in turn, overall satisfaction among radiation oncology patients. [Table: see text]

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US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

BMJ Open ◽

10.1136/bmjopen-2018-022730 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022730 ◽

Cited By ~ 3

Author(s):

Rachel C Forcino ◽

Renata West Yen ◽

Maya Aboumrad ◽

Paul J Barr ◽

Danielle Schubbe ◽

...

Keyword(s):

Decision Making ◽

Family Medicine ◽

Shared Decision Making ◽

Nurse Practitioners ◽

Physician Assistants ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Knowledge And Attitudes ◽

Positive Attitudes

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.Participants272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.ResultsWe found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.ConclusionsRecent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

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