Observer, dentist and family perceptions of shared decision-making consultations about compromised first permanent molars

Treating compromised first permanent molars (cFPM) is complex and requires consideration of multiple factors to identify the different treatment options for each individual. Shared decision-making (SDM) is important to ensure dentists and patients work together to deliberate these options and reach a decision about which treatment right for the individual at the time.

Aim: To explore observer raters who are the researchers, dentist, and families’ perception of shared decision-making consultations for compromised first permanent molars.

Design: Cross-sectional observational study.

Population and setting: Young people (aged 7-11 years), their families and dentists involved in making decisions about cFPM in consultations in the paediatric dentistry clinic, orthodontic clinic and joint orthodontic-paediatric clinic in two NHS hospitals in Yorkshire, England.

Methods: Clinical consultations were observed and audio-recorded to allow three observers to independently score the consultation using a bespoke 14-item SDM measure then reach a consensus score. The family and dentist also scored the consultation using the same items. The scores for each of the 14 items were described from the three different perspectives (observer, family and dentist). Trends in scores across items, individuals and rater groups were described to identify areas of good practice and potential improvement. Inter-rater and intra-rater reliability tests were performed for the observer scores.

Results: In total, 12 consultations were observed. Consultations were scored poorly by observers in key elements of SDM, such as identifying roles in decision-making, assessing understanding, and citing the source of information. Paediatric dentists were scored higher than orthodontists in explaining the clinical issue, treatment options, risks and benefits. Consultations showed similar trends in SDM ratings. Families rated the consultations the highest, while dentists fell in between observers and families in scoring.

Conclusion: Key elements of SDM were missing in consultations about cFPM with evident difference in perceptions of families, dentists, and observers in SDM.