Development and evaluation of a patient decision aid for young people and parents considering fixed orthodontic appliances

Abstract

Objectives: To develop and evaluate a child-centred patient decision aid for young-people, and their parents, supporting shared decision making about fixed orthodontic appliance treatment with dental health professionals, namely the Fixed Appliance Decision Aid (FADA). Methods:The studies were undertaken in a UK teaching dental hospital orthodontic department in 2013-14.The development phase involved an interview study with: a) 10 patients (12-16 years old), and their parents, receiving orthodontic care to investigate treatment decision making and inform the content of the FADA and b) 23 stakeholders critiquing the draft decision aid's content, structure and utility. The evaluation phase employed a pre-/post-test study design, with 30 patients (12-16 years old) and 30 parents. Outcomes included the Decisional Conflict Scale; measures of orthodontic treatment expectations and knowledge.Results: Qualitative analysis identified two informational needs: effectiveness of treatment on orthodontic outcomes and treatment consequences for patients' lives. Quantitative analysis found decisional conflict reduced in both patients (mean difference -12.3, sd 15.3, 95% CI 6.6 to 17.9; p<0.001) and parents (mean difference -8.6, sd 16.6, 95% CI 2.5 to 14.8; p=0.002); knowledge about duration and frequency of orthodontic treatment increased; expectations about care were unchanged. Conclusions:Using the FADA may enable dental professionals to support patients and their parents, decisions about fixed appliance treatments more effectively, ensuring young people's preferences are integrated into care planning.(word count = 217)

Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study

“…Previous research also supports the use of multimedia as a risk communication tool [12,13,[17][18][19]. The present study also provides valuable data about how the risks of orthodontic treatment may be communicated in lay terms in a way that is relevant to patients [16,20]. This evidence can be used to guide the development of innovative risk communication tools and patient resources.…”

“…The literature suggests orthodontic patients have a desire for wide ranging information about the risks of treatment, including effects on diet and speech, treatment duration and procedures, preventative advice and the implications of retainers [16,20,25,32]. These studies however, have not identified the risk information that orthodontic patients most need or use when making choices about treatment and little is known about how young orthodontic patients perceive information about the risks involved in their care.…”

“…In addition, adolescent orthodontic patients appear to be concerned about demineralisation, gingival irritation, relapse and root shortening [20,30,31]. However, adolescent perceptions of orthodontic treatment risks have rarely been explored in detail and little is known about how patients' risk perceptions might change during treatment.…”

“…Qualitative studies suggest that adolescent orthodontic patients can experience many risks of treatment including pain and dietary impacts, dental aesthetic issues, problems with oral hygiene, appliances breaking and issues with retainers [20,[25][26][27][28][29]. In addition, adolescent orthodontic patients appear to be concerned about demineralisation, gingival irritation, relapse and root shortening [20,30,31].…”

“…When communicating risk, clinicians must now understand their patients' individual values, beliefs in relation to the risks of treatment and their risk information needs. However, the development of orthodontic risk communication tools, such as information leaflets [16][17][18], audio-visual information packages [19], decision aids [20,21] and messaging apps [22,23], have rarely been guided by the views of adolescent patients who may have different perceptions of risk information to professionals [24] and primary carers [11].…”