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Volume 29 , Issue 3
May/June 2016

Pages 207–208


Invited Commentary: Qualitative Research Is Important for All Prosthodontists

Dominique Niesten/Nico Creugers


DOI: 10.11607/ijp.2016.3.ic

At the Seoul meeting of the International College of Prosthodontists in September 2015, during a concurrent session in two large, well-attended lecture rooms, a problem became clear. One room featured presentations on the newest technical developments in prosthodontics. The other room’s topic was geriatric dentistry, with speakers addressing the numerous problems associated with complex prosthodontic interventions in older patients. It was disappointing to note that the attendees in each room were largely unaware of the problems and challenges being discussed by the other group.

In some areas of the world, dental expectations have evolved from edentulism at a relatively young age to having a natural, probably restored, dentition into old age. The meeting on modern prosthodontic concepts addressed technical developments that would contribute to or even speed up these generally welcomed advances in dental care. However, since the efficacy and effectiveness of complex dental reconstructions are highly dependent on the recipient’s neuromuscular coordination skills and cognitive capacity,1,2 and given that both of these abilities gradually decline with age, progressively diminishing at older ages, it is necessary to bring this risk more clearly to the attention of clinicians who strive to provide clinical excellence and sophisticated treatments for patients who primarily seek oral health care. Several studies have already reported gaps between what patients want and what clinicians think should be done, and these communication gaps increase with a patient’s age. In fact, dental treatment need in the eyes of clinicians is estimated to be about twice as high as that perceived by older patients.3 One way to bridge these gaps is through truly patient-centered care. Today’s focus on patient-centered care is reflected in the worldwide dental training competency prescriptions. On graduation, a dentist must “acknowledge that the patient is the centre of care, and that all interactions, including diagnosis, treatment planning, and management, must focus on the patient’s best interests.”4 It appears to be as simple as that, but is this really the case? The dentist could use some help, judging from the many formal methods for involving the patient in planning oral health care. The best-known method focuses on shared decision making, where the first step engages the dentist—in fact, any care provider—in exploring a patient’s specific wants and situation, together with his/her perspective on dental interventions, oral health, and oral care behavior. While this sounds commonplace, only through routine practice does it happen in an in-depth manner. Dentists need to learn to ask the right questions to find out what really matters to the patient. In prosthodontics, in contrast to what is normal in a provider-consumer relationship, the standard for care is mainly set by the professional (“clinical excellence”) rather than by the patient (“personalized care”). The problem, of course, is that we are paid to deliver medical devices and not to talk about their implications.

A step further is the dentist providing the patient with the necessary information to make a genuinely shared decision possible. This may seem easy for a health care specialist, but it is more difficult than it looks. It requires better awareness from prosthodontists of the potential long-term adverse outcomes of extensive oral rehabilitations, especially when proposed and/or delivered to middle-aged or older individuals. This step requires integration of patients’ wishes and situation, medical expertise, scientific evidence, and cost considerations to develop viable care options from which a patient can choose. Unfortunately, prosthodontists are recruited only after basic oral health care has failed and therefore are dealing with high-risk patients in complex circumstances. Prosthodontists restore dentitions that are broken down as a result of disease, expecting that rehabilitation is integral to recovery. All too often, a temporary elimination of symptoms is perceived as a successful intervention, while long-term consequences are unknown or even ignored.

To acquire the knowledge and awareness needed to successfully implement these steps, qualitative research methods at population and individual levels are indispensable. Indeed, qualitative research seeks an in-depth understanding of behaviors, contexts, and interrelationships. Evidence obtained from qualitative studies on patient perspectives can provide dentists with a better idea of what may underlie patients’ wishes, and it can serve as a base for relevant questions to ask during the shared decision-making process. For instance, qualitative research has shown that older people with impaired mobility sometimes refrain from seeking dental care because they are reluctant or prefer not to overburden their social support system. In these situations, care providers could specifically ask about the social supports available and how patients think about using these supports for dental care and oral hygiene maintenance.5

An added benefit of qualitative research is that it yields new hypotheses that can be explored quantitatively. Hence, it can strengthen qualitative and quantitative evidence on patient perspectives and treatment outcomes. Dentists can apply qualitative research techniques in their own practice, on individuals or series of patients, through asking in-depth, open-ended questions and descriptive monitoring of cases and treatment outcomes, and by analyzing this information. Sharing such findings with patients can add value to the shared decision-making process.

To optimize the outcome of patient-centered care, dentists need professional expertise and awareness of their ethical responsibility. However, these determinants must be accompanied by deep insight into their patient’s perspective and circumstances—the ability to undergo and appreciate treatment responsibilities and engage in adequate oral hygiene maintenance behavior. Qualitative research should be the key to gaining this insight, and recognizing its added value will make us all better health care providers.

To optimize the outcome of patient-centered care, dentists need professional expertise and awareness of their ethical responsibility. However, these determinants must be accompanied by deep insight into their patient’s perspective and circumstances—the ability to undergo and appreciate treatment responsibilities and engage in adequate oral hygiene maintenance behavior. Qualitative research should be the key to gaining this insight, and recognizing its added value will make us all better health care providers.

Dominique Niesten

Nico Creugers, DDS, PhD

References

1. Brill N, Tryde G, Schübeler S. The role of learning in denture retention. J Prosthet Dent 1960;10:468–475.

2. Preza D, Olsen I, Aas JA, Willumsen T, Grinde B, Paster BJ. Bacterial profiles of root caries in elderly patients. J Clin Microbiol 2008;46:2015–2021.

3. Slade GD, Sanders AE. The paradox of better subjective oral health in older age. J Dent Res 2011;90:1279–1285.

4. Cowpe J, Plasschaert A, Harzer W, Vinkka-Puhakka H, Walmsley AD. Profile and competences for the graduating European dentist—Update 2009. Eur J Dent Educ 2010;14:193–202.

5. Niesten D, van Mourik K, van der Sanden W. The impact of frailty on oral care behavior of older people: A qualitative study. BMC Oral Health 2013;13:61.


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