Information-seeking behaviour in patients exploring orthognathic surgery: A qualitative study.

OBJECTIVE: To explore how orthognathic patients seek information during decision-making. DESIGN: Qualitative, cross-sectional study. SETTING: A hospital in Cumbria, UK. PARTICIPANTS: Prospective orthognathic patients. METHODS: Participants were purposively recruited from joint orthognathic clinics after the original consultation. Semi-structured interviews were conducted via remote video call with nine participants aged 18-30 years. Data collection and reflexive thematic analysis occurred in parallel until thematic saturation was achieved. RESULTS: The central finding of this research was that patients were making informed decisions about orthognathic surgery. Four themes were identified to support this central finding including the following: (1) selective engagement with orthognathic information sources; (2) the central role of patient-specific information from professionals and peers; (3) Internet use to supplement standard information resources; and (4) concerns over information found online. The preferred source of information was verbal from the clinical team as it was trusted and person-specific. Past patients were identified as valued sources of information and establishing contact through digital social media networks was found to be a convenient alternative to face-to-face. Online information found was valued but concerns included information overload, problems establishing applicability and concerns over its credibility. CONCLUSION: Orthognathic patients were making informed decisions about their treatment. This study highlights the central role of the patient-clinician interaction in decision-making, especially in providing patient-specific information. Insight into the nuances of information-seeking behaviours will better inform clinical care. Since patients frequently access online information that is decision-relevant, encouraging patients to discuss online searches will support the shared decision-making process and alleviate any concerns with information found. During consultation, explaining the purpose of an information aid rather than expecting patients to read them separately, may further enhance its usefulness in decision-making. This study identified an unmet need for visual aids, such as real-time images of postoperative recovery. These findings can inform the design of future information resources.

A COnsensus-based Standards for the selection of health Measurement INstruments systematic review of orthognathic patient-reported outcome measures.

INTRODUCTION: This systematic review aimed to identify and appraise the validity studies of patient-reported outcome measures (PROMs) reporting the outcomes of combined orthodontic-orthognathic surgery in treating dentofacial deformity. METHODS: The search strategy was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Systematic Review methodology. The following databases were searched for original studies outlining the development and/or validation of PROMs produced to measure the outcomes of combined orthognathic-orthodontic treatment: EMBASE, MEDLINE, PsycInfo and Scopus. Publications were limited to the English language. Eligibility criteria were applied when considering the studies. Primarily, the psychometric properties and quality of orthognathic-specific PROMs were investigated. Screening of eligible studies was conducted independently by 2 reviewers. Assessment of the methodological quality of the studies and data extraction was conducted by 1 reviewer and assisted by a second reviewer. The COSMIN methodology guided data extraction and analysis, which were divided into 3 stages-a synopsis of studies, evaluation of methodological quality, and summary of evidence. RESULTS: A total of 8695 papers were found; 12 studies met the criteria for inclusion. Regarding the COSMIN Checklist for Assessing Study Qualities, there was evidence that the Orthognathic Quality of Life Questionnaire was the most extensively tested orthognathic-specific PROM in the current literature. The reported evidence was incomplete, as not all psychometric properties had been reliably tested. CONCLUSIONS: Clinicians must use validated PROMs when analyzing patient-reported outcomes. The Orthognathic Quality of Life Questionnaire was shown to be the highest quality orthognathic-specific PROM in the literature but requires contemporary evaluation to suitably reflect the COSMIN guidance.

Characteristics of orthognathic multidisciplinary team clinics in England. Part 1: A questionnaire survey.

BACKGROUND: Orthognathic clinics across England are currently run in a multidisciplinary team (MDT) format. It is, however, likely that there is a large variation in the style of these clinics and care pathways for orthognathic patients across the country. This was a cross-sectional, online questionnaire with a primary aim to obtain information on the way orthognathic care is currently delivered throughout England. The secondary objectives were to determine the compliance to the minimum dataset for record collection. The questionnaire, disseminated to orthodontic consultants, detailed 27 items split into waiting lists for new patients, mechanics of the clinic, support for patients and record collection. RESULTS: A total of 36 participants responded (one was excluded) to give a total of 35 questionnaire responses. Descriptive statistics were used to analyse the data. Of the participants, 34% followed up their patients as per the commissioning guidelines at 1, 2 and 5 years after treatment. Of the participants, 20% said patients' mental health would be screened before adding them to a waiting list, with 26% of participants stating screening was not undertaken for all patients. Of the participants, 11% had available access to psychological support during the MDT meeting and 20% recorded the minimum dataset at the follow-up intervals. CONCLUSION: There are inconsistencies in the orthognathic MDT design across England. Acceptance criteria, support services available and records collected for patients showed substantial variation, highlighting the limited guidance offered by the commissioning guidelines and the potential need to revise the minimum dataset.

Characteristics of orthognathic multidisciplinary team clinics in England. Part 2: A qualitative study.

OBJECTIVE: The aim of the study was to explore the orthodontist's perspective of the strengths and weaknesses of their current multidisciplinary team (MDT) design for orthognathic treatment. PARTICIPANTS AND METHODS: This was a qualitative study using online interviews of orthodontic consultants across England. The data were analysed using thematic analysis. This was the second part of a two-part study, where the first part, an online questionnaire survey, identified the variation in design of orthognathic MDTs across England and was the source of the 19 participants for this study. RESULTS: Seven themes were identified that influenced the design of orthognathic MDTs across England. Close working relationship with the team, access to closed surgery space to conduct the MDT and access to 3D planning were identified as definite strengths of some MDT clinics. Lack of a team psychologist and long waiting lists were identified as weaknesses of some orthognathic MDTs. Teaching and training within MDT clinics were highlighted as a strength of MDTs where surgery spaces were not restricted due to the pandemic. Finally, there was general agreement about revising the orthognathic minimum dataset for records collection as it was not thought to be in the patient's best interest. CONCLUSION: This study was able to identify key areas considered to be determinants of a successful orthognathic MDT design from the orthodontic consultant's perspective. Orthodontic consultants across England prioritised the need for a psychologist in the orthognathic MDT to improve the effectiveness of these clinics.

The consequences of living with a severe malocclusion: A review of the literature.

AIM: To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion. METHODS: A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme. RESULTS: The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias. CONCLUSION: This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.

Differentiation and displacement: Unpicking the relationship between accounts of illness and social structure.

This article seeks to unpack the relationship between social structure and accounts of illness. Taking dentine hypersensitivity as an example, this article explores the perspective that accounts of illness are sense-making processes that draw on a readily available pool of meaning. This pool of meaning is composed of a series of distinctions that make available a range of different lines of communication and action about such conditions. Such lines of communication are condensed and preserved over time and are often formed around a concept and its counter concept. The study of such processes is referred to as semantic analysis and involves drawing on the tools and techniques of conceptual history. This article goes on to explore how the semantics of dentine hypersensitivity developed. It illustrates how processes of social differentiation led to the concept being separated from the more dominant concept of dentine sensitivity and how it was medicalised, scientised and economised. In short, this study seeks to present the story of how society has developed a specific language for communicating about sensitivity and hypersensitivity in teeth. In doing so, it proposes that accounts of dentine hypersensitivity draw on lines of communication that society has preserved over time.