General dental practitioners' perceptions of shared decision making: a qualitative study

Natasha Hayer,Hoda S Wassif

doi:10.1038/s41415-022-3980-9

Natasha Hayer, Hoda S Wassif

Open Access

https://doi.org/10.1038/s41415-022-3980-9

Copy DOI

Abstract

Introduction As patient-centred care becomes more of the focus in healthcare, informed consent is receiving more attention in dental practice as the pinnacle principle in patient care. Shared decision making or person-centred care appears to be taking a back foot in dentistry.Aim This study aims to gain insight into the current views and perceptions of shared decision making by general dental practitioners and how it can be utilised in daily practice.Method Empirical qualitative data were collected using semi-structured interviews of nine dentists working in general practice, with an average of 30 minutes for each interview. The data were analysed using thematic analysis.Results Overall, there was a misunderstanding of what constitutes shared decision making among dental practitioners, with communication focused more on information provision rather than collaborative discussion. There were barriers which prevented full discussions with patients from occurring, some of which directly conflicted with the focus of shared decision making.Conclusion There is a need to provide more clarity of what shared decision making is and how it can facilitate person-centred care in dental practice. Dental practitioners felt that standards and guidelines were not clear; therefore, they were confused as to what was expected of them with regards to communication. More support, in the form of standardised decision-making aids, is needed to assist dental practitioners to streamline the delivery of shared decision making in primary care.

Highlights

As patient-centred care becomes more of the focus in healthcare, informed consent is receiving more attention in dental practice as the pinnacle principle in patient care
In the form of standardised decision-making aids, is needed to assist dental practitioners to streamline the delivery of shared decision making in primary care
The process of informed consent is in line with the General Dental Council (GDC),[17] where there is an omission of actively identifying material risk, sharing responsibility for the decision and obtaining patient views and wishes

Summary

Introduction

As patient-centred care becomes more of the focus in healthcare, informed consent is receiving more attention in dental practice as the pinnacle principle in patient care. Shared decision making or person-centred care appears to be taking a back foot in dentistry. The key feature of paternalistic care is that of ‘doctor knows best’,1 with patients having mostly a passive role in the decision-making process and relying heavily on implicit trust that the doctor will always act in their best interest. Shared decision making (SDM) involves the clinician actively seeking information regarding the patient in a social and psychological context. Research[2,3] outlined that for a discussion to be truly shared, four features must be employed: ‘both the clinician and patient are involved in all processes; both parties share information; both parties express treatment preferences; and agreement is reached’.4. SDM evolves past informed consent, allowing clinicians and patients to ‘think, talk and feel through the situation’,5 providing a prologue and epilogue to the patients’ treatment ‘story’. Its importance can only be explained by overwhelming evidence from extensive research, emphasising better communication having a direct link to better patient healthcare outcomes.[6,7,8,9]

Objectives

Methods

Results

Discussion

Conclusion