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

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Brasil

Dental Press Journal of Orthodontics

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Brasil

Español English

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Sumário

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

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Introdução:

A tomada de decisão compartilhada (TDC) envolve apresentar aos pacientes informações relevantes sobre um problema de saúde e chegar a uma decisão clínica com base em suas preferências. Porém, seu uso em Ortodontia carece de literatura.

Objetivo:

Este estudo teve como objetivo avaliar e comparar as perspectivas de pacientes e dentistas paquistaneses sobre a TDC em diferentes casos.

Métodos:

Um estudo transversal foi realizado em um hospital terciário no Paquistão, envolvendo 90 pacientes categorizados em três grupos (ortopedia dentofacial, cirurgia ortognática, e tratamento convencional não cirúrgico com aparelhos fixos). Após a avaliação clínica e as discussões sobre o plano de tratamento, os pacientes e os dentistas preencheram um questionário com 12 itens, de observação do envolvimento do paciente (OPTION, Observing Patient Involvement) na tomada de decisões, para avaliar suas perspectivas sobre a TDC. Os escores médios da escala OPTION foram comparados usando testes t para amostras pareadas entre dentistas e pacientes, e as comparações intergrupos foram feitas usando testes t para amostras pareadas e coeficientes de correlação de Pearson.

Resultados:

Os escores OPTION foram semelhantes entre pacientes/pais e dentistas. No entanto, foram encontradas diferenças estatisticamente significativas nas questões sobre “diferentes fontes de informação”, “diferentes opções (incluindo a possibilidade de não fazer nada)” e “preocupações relativas à gestão do problema de saúde”, com os pacientes apresentando escores OPTION gerais mais baixos. Os pacientes deram escores OPTION mais baixos na TDC para o tratamento ortodôntico convencional, e escores mais altos para o tratamento ortopédico e a cirurgia ortognática, em comparação com os dentistas.

Conclusões:

O presente estudo revelou um consenso geral nos escores totais médios da escala OPTION entre pacientes e dentistas. Porém, quando estratificados, os pacientes apresentaram maiores escores de TDC para os casos ortopédicos e ortognáticos, e menores escores para o tratamento ortodôntico convencional.

Palavras-chave:
Tomada de decisão compartilhada; Escala diádica OPTION; Envolvimento do paciente

		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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