Patients’ values and preferences in dentistry: current state, next steps
Objectives: Evidence suggests that recommendations which consider patients’ values and preferences (PVPs) are more likely to be accepted by patients. This study sought to evaluate methods for including PVPs during the development of oral health policy and clinical practice guidelines (CPGs).
Methods: We searched PubMed from January 2014 until October 2019 for 1) methodological reports guiding inclusion of PVP data during policy-making, and 2) existing oral health policy documents and CPGs. We compared PVP inclusion frameworks from methodological reports to those utilized specifically in oral health policy and CPGs, to propose guidance for discussion and consensus.
Results: We found 14 methodological reports and 56 policy documents and CPGs that met the inclusion criteria from which we identified five main frameworks :1) patient focus groups or interviews; 2) surveys completed by patients; 3) systematic reviews of PVP research; 4) clinician testimony; and 5) patient inclusion on guideline panels. Of the identified frameworks, those with the greatest generalizability, though resource-intensive, are systematic reviews of PVP research and surveys completed by patients. In contrast, patient inclusion on guideline panels, focus groups, and clinician testimony are less costly but may not provide generalizable patient perspectives. Among existing oral health policy and CPG documents, PVP data is sparse. Oral health-related CPGs primarily relied on guideline panelist testimony, qualitative summary of related PVP studies, or by simply suggesting practitioners consider individual PVPs when making clinical decisions.
Conclusions: The value of PVPs is well-established though PVPs are often not considered during development of oral health policy and CPGs. We call for an investment in well-conducted primary studies including patient-important oral-health outcomes and perspectives. Such studies can provide substantial information in the short-term and inform future systematic reviews, which will further optimize the inclusion of patient perspectives in oral health-related decision-making and increase patient compliance and trust between providers and patients.