Presenting information on dental risk: PREFER study protocol for a randomised controlled trial involving patients receiving a dental check-up.

Rebecca Harris,Louise Laverty,Susan Higham,Christopher Vernazza,Laura Ternent,Stephen Brown,Victoria Lowers,Jimmy Steele,Girvan Burnside

doi:10.1016/j.conctc.2018.05.009

Rebecca Harris, Louise Laverty + Show 7 more

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https://doi.org/10.1016/j.conctc.2018.05.009

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Abstract

IntroductionA new dental contract being tested in England places patients into traffic light categories according to risk (Red = High risk). This reflects health policy which emphasises patients' shared responsibility for their health, and a growing expectation that clinicians discuss health risk in consultations. Alongside this, there are technological developments such as scans and photographs which have generated new, vivid imagery which may be used to communicate risk information to patients. However, there is little evidence as to whether the form in which risk information is given is important.MethodsThe PREFER study is a pragmatic, multi-centre, three-arm, patient-level randomised controlled trial, based in four NHS dental practices, from which 400 high/medium risk patients will be recruited. The study compares three ways of communicating risk information at dental check-ups: 1) verbal only (usual care); 2) a Traffic Light graphic with verbal explanation; 3) a Quantitative Light-Induced Fluorescence (QLF) photograph showing, for example, patches of red fluorescence where dental plaque has been present for two days or more (with a verbal explanation). The study assesses patient preferences using the economic preference-based valuation methodology Willingness-to-Pay (WTP). Any changes in oral self-care (for example in tooth-brushing), will be measured by self-report, and clinical outcome data collected by clinicians and extracted from QLF photographs. Predictors and moderators of any behaviour change will be explored using demographic characteristics and psychological variables from the Extended Parallel Process Model. A cost-benefit framework will explore the financial implications for NHS dentistry of the three risk presentation methods.

Highlights

A new dental contract being tested in England places patients into traffic light categories according to risk (Red = High risk)
This study aims to investigate the benefits of two alternative means of communicating risk information to patients: a colour-coded risk categories (RAG) graphic, and a Quantitative Light-Induced fluorescence (QLF) image of their teeth and gums, in support of the usual verbal communication between dentist and patient - comparing these to usual care
Reform of the NHS dental contract is based on a reorientation from a treatment-focused service, to one which prioritises prevention of disease; with patients participating by improving their oral health behaviours to minimise theoccurrence of disease

Summary

Introduction

A new dental contract being tested in England places patients into traffic light categories according to risk (Red = High risk) This reflects health policy which emphasises patients' shared responsibility for their health, and a growing expectation that clinicians discuss health risk in consultations. The communication of risk information is a fundamental part of most health promotion interventions [1]; and the emphasis on this growing, given government values of freedom, fairness and responsibility articulated in recent health policy [2] This is reflected in the NHS general dental practice context, where a new model of remuneration is being piloted, based on a care pathway approach which separates patients into ‘Red’ (high), ‘Amber’ (medium), and ‘Green’ (low) risk categories (RAG) [3]. No previous studies have compared patients' preferences for different forms of risk information given in a clinical setting [13]

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