Shared decision making for patients needing dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance therapy: a comparison between Pakistani patients’ and clinicians’ perspective

NAJAM, Fatima Naz; JEELANI, Waqar; AHMED, Maheen; SHUJA, Mirza Ezaaf

doi:10.1590/2177-6709.29.4.e242443.oar

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Dental Press Journal of Orthodontics

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ORIGINAL ARTICLE • Dental Press J. Orthod. 29 (4) • 2024 • https://doi.org/10.1590/2177-6709.29.4.e242443.oar copy

Shared decision making for patients needing dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance therapy: a comparison between Pakistani patients’ and clinicians’ perspective

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Shared decision making (SDM) involves presenting patients with relevant information about a health issue and reaching a clinical decision based on their preferences. However, its application in orthodontics lacks documentation.

Objective:

This study aimed to assess and compare the perspectives of patients and clinicians on SDM in different cases.

Methods:

A cross-sectional study was conducted at a tertiary care hospital in Pakistan, involving 90 patients categorized into three groups (dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance treatment). Following clinical assessment and treatment plan discussions, patients and clinicians completed a 12-item dyadic observing patient involvement in decision making (OPTION) questionnaire, to gauge their perspectives on SDM. Mean OPTION scale scores were compared using paired sample t-tests between clinicians and patients, and intergroup comparisons utilized paired sample t-tests and Pearson correlation coefficients.

Results:

OPTION scores were similar between patients/parents and clinicians. However, statistically significant differences were found regarding the questions about “different sources of information”, “different options (including the possibility of doing nothing)” and “concerns regarding management”, with the patients giving overall lower OPTION scores. Patients gave lower SDM OPTION scores for conventional orthodontic treatment, but higher scores for orthopedic and orthognathic surgery, as compared to the clinicians.

Conclusions:

The current study revealed an overall consensus in the mean total scores of OPTION scales between patients and clinicians. However, when stratified, patients showed higher SDM scores for orthopedic and orthognathic cases, and lower scores for conventional orthodontic treatment.

Keywords:
Shared decision making; Dyadic OPTION scale; Patient involvement

		Total score of OPTION scale Mean + SD	p
Patients gender^†	Male (n=55)	39.328 ± 5.65	0.642
Patients gender^†	Female (n=34)	38.936 ± 5.91	0.642
Clinicians gender^†	Male (n=55)	39.632 ± 4.87	0.104
Clinicians gender^†	Female (n=35)	39.56 ± 2.90	0.104
Patients’ socioeconomic status^‡	Low income (n=28)	38.2 ± 5.52	0.395
	Middle income (n=46)	39.616 ± 5.69
	High income (n=16)	39.68 ± 6.20
Patients education status^‡	Primary (n=16)	36.248 ± 5.46	0.038*
	Secondary (n=48)	39.864 ± 5.70
	Graduation (n=21)	39.563 ± 5.52
	Specialization (n=4)	40.8 ± 2.94
Clinicians level^†	Residents (n=46)	39.144 ± 6.36	0.105
Clinicians level^†	Consultants (n=44)	39.016 ± 6.41	0.105

QUESTION	Score of OPTION scale Mean ± SD		p	r
QUESTION	Patients (n=90)	Clinicians (n=90)
1. A health problem related to my teeth/face was identified, where it was made clear that a decision was needed	3.40±0.73	3.45±0.62	0.614	-0.054
2. More than one way to manage health problem was described	3.02±0.88	3.02±0.91	0.365	0.097
3. Different sources of information (e.g leaflets, websites, contact with other people) to help make the decisions were offered	2.42±1.20	2.34±1.18	0.031*	0.227
4. Different options (including the possibility of doing nothing) were discussed	2.73±1.07	2.61±1.04	0.032*	0.226
5. The advantages, disadvantages and possible outcomes of options were discussed	3.19±0.76	3.21±0.62	0.429	-0.084
6. Ideas or expectations about managing the health problem were discussed	2.92±0.96	3.09±0.69	0.492	-0.073
7. Concerns or worries about managing the health problem were discussed	2.91±0.93	3.08±0.70	0.007*	0.284
8. It was made sure that information had been understood	3.42±0.56	3.49±0.50	0.875	0.017
9. There were opportunities to ask questions	3.41±0.49	3.46±0.63	0.962	0.005
10. The preference to take part in the decision (or not) was respected	3.47±0.52	3.46±0.60	0.166	-0.147
11. During the consultation, a decision was made or there was an agreement to postpone making the decision	2.93±1.00	3.17±0.81	0.897	0.014
12. The possibility of coming back to the decision was discussed	3.13±0.73	3.14±0.66	0.785	0.029
Total score (48)	36.97±5.72	36.97±4.15	0.426	0.446

QUESTION	Score of OPTION scale Mean±SD		p	r
QUESTION	Patients (n=30)	Clinicians (n=30)
1. A health problem related to my teeth/face was identified, where it was made clear that a decision was needed	3.40±1.03	3.53±0.50	0.581	0.105
2. More than one way to manage health problem was described	2.87±0.93	3.03±0.89	0.367	0.390
3. Different sources of information (e.g leaflets, websites, contact with other people) to help make the decisions were offered	2.33±1.15	2.30±1.14	0.033*	0.130
4. Different options (including the possibility of doing nothing) were discussed	3.47±1.10	2.37±1.12	0.678	0.367
5. The advantages, disadvantages and possible outcomes of options were discussed	3.00±1.05	3.17±0.79	1.000	0.000
6. Ideas or expectations about managing the health problem were discussed	2.80±1.15	3.07±0.82	0.623	0.094
7. Concerns or worries about managing the health problem were discussed	2.80±1.06	3.00±0.78	0.024*	0.412
8. It was made sure that information had been understood	3.47±0.50	3.57±0.50	0.962	0.009
9. There were opportunities to ask questions	3.43±0.50	3.47±0.81	0.977	0.006
10. The preference to take part in the decision (or not) was respected	3.47±0.50	3.43±0.67	0.574	0.107
11. During the consultation, a decision was made or there was an agreement to postpone making the decision	2.77±1.04	3.27±0.78	0.167	0.259
12. The possibility of coming back to the decision was discussed	2.93±0.86	3.13±0.77	0.542	0.116
Total score (48)	35.73±5.98	37.33±4.17	0.450	0.143

QUESTION	Score of OPTION scale Mean±SD		p	r
QUESTION	Patients (n=30)	Clinicians (n=30)
1. A health problem related to my teeth/face was identified, where it was made clear that a decision was needed	3.57±0.50	3.30±0.79	0.154	0.267
2. More than one way to manage health problem was described	3.27±0.78	2.90±0.99	0.515	0.058
3. Different sources of information (e.g leaflets, websites, contact with other people) to help make the decisions were offered	2.50±1.16	2.23±1.27	0.762	0.073
4. Different options (including the possibility of doing nothing) were discussed	3.07±0.74	2.73±0.98	0.702	0.124
5. The advantages, disadvantages and possible outcomes of options were discussed	3.37±0.55	3.07±0.52	0.014*	0.445
6. Ideas or expectations about managing the health problem were discussed	3.23±0.62	2.97±0.71	0.260	0.212
7. Concerns or worries about managing the health problem were discussed	3.00±0.91	3.07±0.45	0.178	0.253
8. It was made sure that information had been understood	3.57±0.67	3.47±0.50	0.972	0.007
9. There were opportunities to ask questions	3.60±0.49	3.50±0.50	1.000	0.000
10. The preference to take part in the decision (or not) was respected	3.67±0.47	3.37±0.61	0.411	0.156
11. During the consultation, a decision was made or there was an agreement to postpone making the decision	3.30±0.70	3.17±0.69	0.353	0.176
12. The possibility of coming back to the decision was discussed	3.37±0.49	3.10±0.66	0.538	0.117
Total score (48)	39.50±4.84	36.86±3.88	0.893	0.026

QUESTION	Score of OPTION scale Mean±SD		p	r
QUESTION	Patients (n=30)	Clinicians (n=30)
1. A health problem related to my teeth/face was identified, where it was made clear that a decision was needed	3.24±0.51	3.52±0.50	0.788	0.052
2. More than one way to manage health problem was described	2.93±0.90	3.13±0.86	0.769	0.376
3. Different sources of information (e.g leaflets, websites, contact with other people) to help make the decisions were offered	2.43±1.33	2.50±1.13	0.041*	0.411
4. Different options (including the possibility of doing nothing) were discussed	2.67±1.26	2.73±1.01	0.024*	0.769
5. The advantages, disadvantages and possible outcomes of options were discussed	3.20±0.55	3.40±0.49	0.692	0.075
6. Ideas or expectations about managing the health problem were discussed	2.73±0.98	3.23±0.50	0.289	0.200
7. Concerns or worries about managing the health problem were discussed	2.93±0.82	3.17±0.83	0.379	0.167
8. It was made sure that information had been understood	3.23±0.43	3.43±0.50	0.978	0.005
9. There were opportunities to ask questions	3.20±0.40	3.40±0.56	0.752	0.060
10. The preference to take part in the decision (or not) was respected	3.27±0.52	3.57±0.50	0.713	0.070
11. During the consultation, a decision was made or there was an agreement to postpone making the decision	2.73±1.14	3.07±0.94	0.102	0.305
12. The possibility of coming back to the decision was discussed	3.10±0.75	3.20±0.55	0.863	0.033
Total score (48)	35.65±5.59	38.41±4.39	0.207	0.241

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