Shared decision-making in orthodontics: the clinician's perspective

Background: Shared decision-making (SDM) in orthodontics is not carried out as well as it could be. Orthodontic clinicians are key stakeholders in instigating and facilitating the SDM process. Capturing information about clinicians’ experiences and their perceptions regarding what might make SDM encounters easier or more challenging could help to identify interventions aimed at improving the SDM processes.
Aim: To examine orthodontic clinicians’ perspectives and experiences of decision-making encounters with people.
Design: Cross-sectional survey using an online questionnaire.
Participants: Orthodontic consultants, specialty trainees, specialists and dentists with a special interest in orthodontics.
Method: Potential participants were invited through the British Orthodontic Society via email. The validated iSHARE questionnaire was used to capture clinicians’ perspectives of SDM by reflecting on a previous patient encounter of their choosing. The theoretical domains framework (TDF) was used to analyse free text responses regarding barriers and facilitators to engaging in SDM.
Results: 122 unique responses revealed that clinicians felt they engaged most in highlighting choice awareness, explaining the differences between treatment options, and giving the patient enough time to make a decision. The least frequently reported SDM practices were patient-related: patients asking questions about treatment, stating their values and weighing up the advantages and disadvantages of treatment. Commonly reported barriers to SDM were a lack of time, uncertainty around treatment outcomes, and patients’ ability to understand information. Commonly reported facilitators included patients taking an active role in the SDM process, having enough time, and using/having access to resources which support information-giving.
Conclusions: Clinicians’ perception of their engagement in SDM in orthodontic consultations varies. This research highlights potential areas to target when designing interventions aimed at improving SDM in orthodontics.