Do You Know How Your Patients Make Decisions?
Patients sometimes have to make important decisions that will affect the outcome of their dental health and, according to the NHS, more than 40% of people in the UK want to be more involved in decisions about their care .
Shared decision-making enables clinicians and patients to work together to understand the medical issue that needs addressing, so they can choose appropriate treatment together, with the best interests of the patient in mind. 
As a healthcare professional, dentists have their own code of conduct that they need to abide by. The best interests of the patient are, of course, central to this. It’s important to consider, however, that each patient will go through their own way of processing the different treatment options presented to them before they make a decision. 
The psychology involved in making decisions about dental treatment, is much the same as the psychology involved in other decisions. Patients will generally go through several stages before reaching a final decision. 
The stages of the decision making process can broadly be split into three key categories. 
Awareness. It might seem obvious, but the first step in making a decision is identifying that there is a choice to be made.  In the case of dentistry, this is where the dentist will diagnose the problem and explain it to the patient. Some patients will already be aware that they have an issue, while others may be oblivious until it is identified in a routine check-up. It will sometimes take time for the patient to fully grasp and accept the condition or issue that needs addressing. 
Consideration. Once the problem has been identified, the dentist or practice coordinator will present one or more treatment plans to the patient. The patient will then need to assess all the information and compare options before they decide what is best for them. This is generally done via a shared decision making process where patients are actively provided with clinical evidence regarding expected treatment outcomes and given an opportunity to ask questions. 
Decision. The patient and dentist will often work together to decide which option will meet the needs of the patient most effectively. It’s important that the patient is in full agreement that this decision really is the best option for them.  Evidence suggests that the use of decision aids can really help patients to feel involved and informed about their options so they can make confident decisions. 
Central to this sharing process is an ongoing dialogue between the dentist and patient, ensuring that the patient has appropriate access to all the clinical and practical information they need to commit to the right treatment for them. 
It’s important to recognise that individual experiences and environment of every patient will have an impact on their decision making process.  Some clinicians report that their patients prefer clear direction from a medical professional, while others patients require very detailed information about every possible option available to them and like to be left to make the decision independently. The shared decision making process should respect the patient’s preference and ensure that their needs remain central. 
The patient may also feel more comfortable discussing their options with a treatment coordinator or another member of the team in a less clinical and more relaxed environment away from the dental chair. Whether you have the support of a patient coordinator or not patients need time and space to consider the options available to them.
There are certainly lots of things to consider, and the skills dentists need to help patients make decisions aren’t always taught in dental college.  So, what are the best methods to help patients move seamlessly through the decision making process?
The better trained a dental professional is to communicate the treatment plan to his or her patient, the more involved, informed and relaxed the patient will feel. Ultimately this will increase the chances of a treatment plan being accepted. The key is to explain things clearly and simply, and to avoid using complex clinical information. Visual aids, digital images or even physical models that the patient can touch and feel, can also help them to understand the treatment, and importantly the results. 
While the dentist wants to provide the best clinical option, it is important that the patient is in agreement about what the right course of action is. This process is made much smoother when there is a strong relationship of trust between the dentist and the patient. Trust starts to be built from the moment a patient enters the dental practice; their first meeting with the dentist; through ongoing care visits; and other interactions with the team. 
Considering that almost half of UK adults have a fear of the dentist and 12% of these suffer from an extreme dental anxiety , patients need to feel well supported not just by the dentist, but by the whole team. Many dental practices are starting to use practice or treatment coordinators to help build the confidence of patients. A patient or treatment coordinator can also help to explain certain issues, such as the financial commitments that are involved, so the dentist can focus on the clinical aspects of treatment. 
Information specially tailored to your patient’s individual needs can be helpful in reinforcing your explanation of the problem and the need for action. Ensuring that it is the patient who is treated, not just the symptom, are principles supported by the British Dental Association.  There is a stronger link, for example, between shared decision making and autonomy in older patients compared with younger people, possibly because older people are more comfortable taking a less active role in the decision making process. Our white paper on how to talk to your millennial patients provides more helpful tips on how to support this group of patients.
Encouraging patients to undertake complex, often expensive, but ultimately necessary, dental procedures can take time and patients will be hesitant to invest in a treatment plan they don’t fully understand. They will need time to think about it, discuss it with family and friends, before reaching the final stage of the decision-making process.  No one likes feeling rushed into making a decision, but it’s important that serious issues don’t go untreated for months, so patients need to know that there is someone who can respond to any questions or queries they have. 
One of the most common sources of patient dissatisfaction is not feeling properly informed about and involved in their treatment.  When a patient is dissatisfied with the decision-making process surrounding their treatment, then they are less likely to make the best choice with regard to their long-term health. 
When it comes to treatment it’s vital that patient care is at the centre. Encouraging patients to play an active role in decisions about their care can be an effective way of ensuring that dental treatment and oral disease management are appropriately tailored to the individual. Ultimately, what should be at the heart of any shared decision making is patient safety, care and good clinical conduct. 
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