Dentists Behavioral Factors Influencing Early Detection of Oral Cancer: Direct Clinical Observational Study

Abstract

This study aimed to investigate the possible factors affecting dentists’ behavior relating to performing oral cancer examinations as part of routine clinical examination. A total of 95 direct clinical observation sessions—utilizing an instrument consisting of 19 evidence-based observational criteria for oral cancer examinations—were observed by four calibrated dentists. Thirty-two final-year students, 32 interns, and 31 faculty members of Jazan Dental School were examined between April 9 and May 4, 2017. A descriptive analysis was conducted to investigate the frequencies/percentages of the performed observing criteria by all examiners. ANOVA and Tukey tests were carried out to investigate the difference between the examiner groups. A total number of 32 patients participated in the study, whereby each patient was examined by three different examiners from each group, as well as by the attending observer/s. Fewer than 50% of the examiners performed the clinical steps necessary for an oral cancer examination—for example, taking into account past medical history, as well as extra and intra-oral examinations. More than 90% of the examiners examined hard tissue, whereas fewer than 30% of them educated their patients about possible risk factors. A significant difference between examiner groups was found in favor of faculty members. A gap between knowledge and actual practice of oral cancer examinations was evident: majority of participants failed to perform the necessary steps for an oral cancer examination. Previous experience and confidence in performing oral cancer examination are possible explanations for the dentist’s behavior toward oral cancer examination.

Using Intervention Mapping to Develop ISAC, a Comprehensive Intervention for Early Detection and Prevention of Oral Cancer in Saudi Arabia

“…As a result, the current developed intervention (ISAC) aimed to improve OC practices at Jazan University by preparing its dental graduates to perform full OC clinical examinations and patient education, which will lead to early detection and prevention of OC. The needs assessment, at both the level of dentists and patients, has revealed major issues relating to dentists' behavior toward OC practice and educating patientsfor example, not informing patients of OC examinations, not performing full OC examinations, and not educating their patients on the risk factors, if needed, or referring them to tobacco-cessation services [3,11,13]. Those major issues were covered in the main pillars of ISAC.…”

“…Step 1: Logic Model of the Problem We have conducted needs assessments that involved the following: (a) Evidence reviews of existing data on OC problem at Jazan region; (b) a quantitative study to assess dentists' knowledge of OC [11]; a qualitative study to explore dentists' perspectives related to OC utilizing the grounded theory approach [12]; (c) direct clinical observation of dentists in their routine dental practices by four calibrated dentists (the observers who received calibration trainings to improve their scoring accuracy and consistency) [13]; (d) an exploratory sequential mixed methods design to investigate dental patients' behavior, thoughts, opinions, and needs for oral cancer information, and dentists' behavior regarding prevention and examination of oral cancer [14]; and (e) an assessment and evaluation of JDS organization context factors [12][13][14].…”

“…The findings from the needs' assessments in addition to group brainstorming sessions revealed a gap that exists between knowledge and practice of OC examination among JDS dentists [3,[11][12][13][14]. The main determinants that were found to be related to the personal contributing behaviors were as follows: low awareness of OC status in Jazan, dentists' lack of experience, skills and self-efficacy, and the negative descriptive norms regarding oral cancer practices in JDS [3,[11][12][13]. The determinants of the environmental behaviors were interns lacking exposure to OC patients and having clinical guidelines that do not include OC.…”

“…Dental interns were the target group because they are the first to see the patients in JDS-clinics and they had the lowest score in terms of performing OC examination and patient education [13]. The intervention period was specified as 1 year due to the structure of JDS interns' rotations, as all interns must practice at JDS within their 1-year internship.…”

Using the Exploratory Sequential Mixed Methods Design to Investigate Dental Patients’ Perceptions and Needs Concerning Oral Cancer Information, Examination, Prevention and Behavior

“…In addition to the silent nature of oral cancer, the routine practice of oral cancer examinations, which is associated with a better prognosis of the disease [ 20 ], is usually not practiced by dentists in countries such as the UK [ 21 ]. This lack of routine checkup for oral cancers is also prevalent among dentists in the Jazan region of Saudi Arabia [ 22 , 23 ]. Therefore, by utilizing an exploratory sequential mixed methods design (three-phase procedure), the primary objectives of the present study were as follows: to investigate the thoughts, opinions and needs for oral cancer information and dentists’ behavior regarding prevention and examination of oral cancer, as well as patients’ behavior regarding oral cancer (qualitative phase) among dental patients visiting the Jazan Dental School (JDS).…”