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The influence of patients' decisions on treatment planning in restorative dentistry Jagdip S Kalsi Kenneth W Hemmings Dental Update 2024 40:9, 707-709.
Authors
Jagdip SKalsi
BDS, MSc, MFDS, MJDF MRD, FDS RCS
Core Dental Trainee in Restorative Dentistry, Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD
As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected.
This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out.
Clinical Relevance: Many psychological and social determinants influence patients' values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.
Article
Evidence-based treatment planning in restorative dentistry requires a sound diagnosis, and takes into account the pyramid of best available research, clinical factors and patients' decisions (Figure 1). All three factors influence decision-making but patients' subjective decisions, based on recommendations made to them by the dentist, ultimately drive management. Health service providers may externally influence the decision-making process between the dentist and the patient if certain interventions are favoured or excluded on financial grounds.
Ideal treatments should be based on the best available literature, though most treatment plans are, rightly, heavily influenced by patients' wishes and expectations, which may not be based on sound knowledge. Patients' desires should be ascertained at the first treatment planning consultation to ‘sieve’ whether these are realistic and feasible within the clinician's skill-mix, experience and knowledge. No dentist should carry out any treatment that could harm his/her patient.
In most cases, patients will engage with dentists and deliberate on the full options available, including referral, to decide on a treatment approach which suits them. Many psychological and social determinants influence patients' values, which can lead to treatment plans that may not be regarded as treatment of choice according to the literature. For example, patients may feel that particular interventions do not inherently work and are destined to fail: some will categorically claim that periodontal or endodontic treatment ‘does not work’. Individual patients' wishes, values and expectations of dental treatment are variable. The same treatment plan is rarely provided more than once, even though presenting diagnoses may be the same.
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