Influences on negotiating clinical need & decision making
Lead Research Organisation:
Newcastle University
Department Name: Inst of Health and Society
Abstract
This study examines how patients and dentists decide whether or not to pursue treatments involving costly dental implants that are paid for by patients. We will provide conclusions and recommendations about how such treatment decisions can be managed.
People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments - such as removable dentures - and is usually only available if paid for privately. We know very little about how dentists make decisions about offering such treatments, or what patients consider when deciding whether or not to pay for them.
Primary care dentists in North East England will be surveyed to identify how and where implant treatment is provided. A sample of dentists and patients will be interviewed to find out how decisions about whether or not to pursue dental implants are reached.
The study has wider relevance to society and other healthcare providers because it will provide information about what factors clinicians consider when offering patients treatments that they must pay for. We will also determine what influences patients’ decisions when faced with the choice of having a treatment that incurs a personal financial cost.
People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments - such as removable dentures - and is usually only available if paid for privately. We know very little about how dentists make decisions about offering such treatments, or what patients consider when deciding whether or not to pay for them.
Primary care dentists in North East England will be surveyed to identify how and where implant treatment is provided. A sample of dentists and patients will be interviewed to find out how decisions about whether or not to pursue dental implants are reached.
The study has wider relevance to society and other healthcare providers because it will provide information about what factors clinicians consider when offering patients treatments that they must pay for. We will also determine what influences patients’ decisions when faced with the choice of having a treatment that incurs a personal financial cost.
Technical Summary
Aim: This study will examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources.
Objectives: This research will examine how interpretations of need and subsequent decisions about treatment are mediated by social and psychological factors, as well as the financial environment in which such joint decision making takes place. Specifically it will:
1. Examine how notions of clinical need are negotiated by both patients and health professionals,
2. Critically investigate the relationship between constructs of clinical need and treatment decisions,
3. Assess the relative influences of professional, physicality (symptoms and/or aesthetics), social and psychological factors on patients? decision making processes, and
4. Compare and contrast the ways in which patients? decision making processes may change when they incur a personal financial cost.
Setting: Dentistry, and the provision of Implant Supported Over Dentures (ISOD), is the treatment setting in which this study of decision making will be conducted. ISOD provision is an appropriate subject for this study as it is a treatment which has strong clinical and patient support, yet is only available to a small number of people without cost through secondary care, and therefore patients are often required to pay for it in primary care.
Method: This study comprises 3 phases:
1. A telephone administered scoping questionnaire will be conducted with all General Dental Practitioners (GDPs) in the locality (n=322) to provide baseline data about current practice, and to provide a sampling frame for Phases 2 & 3.
2. Individual qualitative interviews will be conducted with 30 GDPs to ascertain their views and experiences of negotiating clinical need and treatment decisions for edentulous patients.
3. Individual qualitative interviews will be conducted with 60 patients who have been offered ISOD to ascertain their views and experiences of negotiating clinical need and treatment decisions for edentulous patients
Analysis: Scoping data will be analysed descriptively. The qualitative data will be analysed using the constant comparative method.
Outcome: This project will develop an empirically derived conceptual model, applicable to the management of other chronic diseases. It will identifiy and specify the relative importance of a range of social, psychological, and clinical influences on determining clinical need and deciding upon treatments that incur a personal financial cost. The results will provide valuable information about the likely demand for certain treatment services and the trade-offs that patients are willing to make to achieve their desired outcomes.
Objectives: This research will examine how interpretations of need and subsequent decisions about treatment are mediated by social and psychological factors, as well as the financial environment in which such joint decision making takes place. Specifically it will:
1. Examine how notions of clinical need are negotiated by both patients and health professionals,
2. Critically investigate the relationship between constructs of clinical need and treatment decisions,
3. Assess the relative influences of professional, physicality (symptoms and/or aesthetics), social and psychological factors on patients? decision making processes, and
4. Compare and contrast the ways in which patients? decision making processes may change when they incur a personal financial cost.
Setting: Dentistry, and the provision of Implant Supported Over Dentures (ISOD), is the treatment setting in which this study of decision making will be conducted. ISOD provision is an appropriate subject for this study as it is a treatment which has strong clinical and patient support, yet is only available to a small number of people without cost through secondary care, and therefore patients are often required to pay for it in primary care.
Method: This study comprises 3 phases:
1. A telephone administered scoping questionnaire will be conducted with all General Dental Practitioners (GDPs) in the locality (n=322) to provide baseline data about current practice, and to provide a sampling frame for Phases 2 & 3.
2. Individual qualitative interviews will be conducted with 30 GDPs to ascertain their views and experiences of negotiating clinical need and treatment decisions for edentulous patients.
3. Individual qualitative interviews will be conducted with 60 patients who have been offered ISOD to ascertain their views and experiences of negotiating clinical need and treatment decisions for edentulous patients
Analysis: Scoping data will be analysed descriptively. The qualitative data will be analysed using the constant comparative method.
Outcome: This project will develop an empirically derived conceptual model, applicable to the management of other chronic diseases. It will identifiy and specify the relative importance of a range of social, psychological, and clinical influences on determining clinical need and deciding upon treatments that incur a personal financial cost. The results will provide valuable information about the likely demand for certain treatment services and the trade-offs that patients are willing to make to achieve their desired outcomes.