Title

Developing a decision aid to support shared decision making regarding recall intervals in general dental practice.

Principal / Lead investigator

• Dr Anwen Cope, Specialty Trainee and Honorary Lecturer, Cardiff and Vale University Heath Board.

Co-investigators / research team

• Professor Ivor G. Chestnutt, Professor and Honorary Consultant in Dental Public Health, Cardiff University.
• Dr Fiona Wood, Reader, Division of Population Medicine, Cardiff University.
• Dr Natalie Joseph-Williams, Lecturer in Improving Patient Care, Division of Population Medicine, Cardiff University.
• Mr Anup J. Karki, Consultant in Dental Public Health, Public Health Wales.
• Ms Candida Lovell-Smith, Patient and Public Involvement Representative.
• Mr Emyr Roberts, Principal Dentist and Practice Owner, The Courtyard Dental Care, Cardiff.

Type of study

Part 1: qualitative study

Part 2: development of a decision support aid

Part 3: mixed-method feasibility study

Summary

Background to the research
Many patients visit their dentist every 6 months for a check-up. However this may not be the best use of patients’ time and money, or NHS resources. In 2004, the National Institute for Health and Care Excellence (NICE) recommended that the time between dental check-ups should be tailored for each patient, based on how likely they were to develop diseases such as tooth decay, gum disease, or oral cancer. This guidance said that there was no longer a need for many patients to attend every 6 months and that for adult patients who were at low risk of developing dental disease, the time between check-ups could be increased up to a maximum of 24 months. Since the time between check-ups depends on a patients’ risk of developing disease, we call this ‘risk-based recall’.

However, over a decade on from the publication of the NICE guidance, 80% of adult NHS dental patients still go for check-ups every 6-8 months. This is a problem because the resources spent on check-ups for low-risk patients who attend too regularly could be better used to provide care for people who have struggled to get a dentist for a long time or who have toothache. This has been identified as a priority by the Welsh Government, which is one of the reasons why we are undertaking this research. 

Aim of the research
The research team would like to develop a ‘decision aid’ which will 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. 

What we hope to discover
This project has 3 parts. 

Part 1 will explore the attitudes of dentists and patients to risk-based recall. We want to understand the reasons why dentists are not currently following the NICE guidance, and what patients consider to be the most important factors when making a decision regarding the time between dental 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 recalls vs. longer gaps between check-ups. The decision aid will be developed with input from practicing dentists and patients. We aim to create a product which could be used during check-ups in dental practices. 

In Part 3 we will do a small test of the decision aid with dentists and 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 in the future. We will also interview dentists and patients to understand how user-friendly the decision aid is, and how they see it being used in practice.

How could this research potentially benefit patients?

It is important that patients are involved in decisions regarding their care. A decision aid can be used to support this process and to help patients arrive at a decision that most aligns with their values. Not only will this help patients receive a recall interval appropriate to their needs, there is evidence that patients who are more active in making decisions about their health typically have better outcomes.

Public / patient involvement

Two lay representatives were involved in the design of the research. Their contributions have had a direct impact on the proposed recruitment strategies, the topics that will be explored during interviews, and the language used in the decision aid.

Who is the study sponsor?

Cardiff and Vale University Health Board

Does the study involve commercial partnership activity?

No

Funder

Research for Patient and Public Benefit, Health and Care Research Wales, Welsh Government            

Total grant value

£ 221,768

Amount accruing to Wales

£ 221,768

Start date

01/10/2018

End date

30/06/2020

Further information (e.g. related web link)

To follow

Outputs generated (Reports / Publications / Impact) 

To follow