PRIDA - Patient Recall Interval Decision Aid study
Research type
Research Study
Full title
Developing a decision aid to support shared decision making regarding recall intervals in general dental practice
IRAS ID
256630
Contact name
Anwen L. Cope
Contact email
Sponsor organisation
Cardiff and Vale University Health Board
Duration of Study in the UK
1 years, 5 months, 31 days
Research summary
Summary of Research
National guidance recommends that the time between dental check-ups should be personalised for each patient, based on their likelihood of developing diseases such as tooth decay, gum disease, or oral cancer. We call this ‘risk-based recall’. Therefore, there is no need for many patients to attend every 6 months – for some patients it may be more frequently, and for some, less. However, over a decade on from the publication of this guidance, 80% of adult NHS dental patients still go for check-ups every 6-8 months.
The research team would like to develop a paper-based ‘decision aid’ which could be used in appointments to support patients and dentists to reach a decision together about what is the best length of time between dental check-ups for a particular patient.
This project has 3 parts.
Part 1 will explore the attitudes of dentists and patients to risk-based recall. 20 dentists and 20 patients will be interviewed to understand the reasons why dentists are not currently following the national guidance, and what patients consider to be the most important factors when making a decision regarding the time between check-ups.In Part 2 we will design the decision aid. This will be a paper-based tool which will outline the risks and benefits of 6-monthly vs. longer/shorter gaps between check-ups. The decision aid will be developed with input from 5 practising dentists and 10 lay individuals.
In Part 3 we will do a small test of the decision aid with 10 dentists and 100 dental patients. We will collect information that will help us understand whether it is possible to run a larger, more robust study of the decision aid. We will also interview 10 dentists and 20 patients to understand how user-friendly the decision aid is, and how they see it being used in practice.
Summary of Results
What problem does this research address?
Not everyone needs to go to the dentist for a check-up every 6-months. The National Institute for Health and Care Excellence (NICE) recommends that the time between dental check-ups should be based on the individual needs of every patient and how likely they are to develop problems such as tooth decay or gum disease. This means that patients at higher risk of problems should attend most frequently (every 3- or 6-months) and that patients who have good oral health should visit less regularly (every 12-, 18- or 24-months). However, NHS data shows that most people still attend every 6-months.What did the research involve?
When patients are involved as equal partners in decisions about their health it is called ‘shared decision making’. We wanted to explore whether shared decision making could be used in decisions about the frequency of dental check-ups.
We did three things as part of the research:
1. We interviewed 25 NHS patients and 25 NHS dentists. We wanted to know the reasons why dentists were not following the NICE guidelines and what patients consider to be the important factors when asked to consider changing how often they go for check-ups.
2. We developed a leaflet (a ‘decision aid’) that could answer common questions that patients may have about the frequency of their dental check-ups. This leaflet could also be used by dentists to start a conversation with patients about the frequency of their check-ups. We involved 9 lay individuals and 5 dentists as potential users.
3. We worked with Health Education and Improvement Wales to develop an online course to help dental teams develop skills to involve patients more in decisions about their care.What did the research find?
Both dentists and patients were reluctant leave 24-months between check-ups. Most of the patients that we spoke to wanted to be seen at least once a year. Dentists were concerned that some patients did not seem to want to visit every 3 months. Interviews with patients highlighted that this might be due to time, travel or patient charges. Many patients wanted to be involved in decisions about fillings and extractions but were happy to be guided by their dentist about how often they should have a check-up. Although dentists thought that it was important to involve patients in decisions, some were concerned about the time it could take. Others were worried about what would happen if a patient insisted on coming more or less frequently than the dentist advised. Dentists were also anxious that the time needed for discussions about frequency of check-ups might interfere with them giving patients important advice about their oral health.What has the research produced?
The research has produced:
- A bilingual ‘decision aid’ about dental check-ups that is available for use in dental practices
- An online course for dental teams
The findings of the research were disseminated to the health and research communities via conferences (South West Academic Primary Care) and journals (British Dental Journal) and to the wider public via websites and the media.Where did this research take place?
The research was led by Cardiff and Vale University Health Board, however, patients and dentists from all over Wales took part.Who did this research?
The research team included dentists from the NHS, experts in shared decision making from Cardiff University, and a patient and public research partner who was pro-actively involved and contributed to all stages of the research by offering the patient perspective.REC name
East of England - Cambridge Central Research Ethics Committee
REC reference
19/EE/0031
Date of REC Opinion
5 Feb 2019
REC opinion
Further Information Favourable Opinion