Developing a decision aid to support shared decision making regarding risk-based recall intervals in general dental practice

Clinical guidelines recommend that dental recall intervals should be personalised for each patient based on their risk of disease. Despite this, most patients attend their dentist every six months. As a result, a substantial proportion of NHS dental resources are spent providing check-ups to dentally-fit individuals who are at low risk of disease. Dental policy makers want to encourage greater use of risk-based recall intervals in general dental practice. It is argued that increased use of risk-based recall would free up clinical resources which could be used to provide care for more patients with active dental disease, many of whom have not accessed dental care in a long time.

However, it is important that patients are supported by healthcare professionals to make informed decisions about their care. This will involve discussions between dentists and patients regarding the risks and benefits of risk-based recall in order to arrive at a shared decision. This process can be supported by decision aids which build upon patients' existing capabilities to help them arrive at a deliberated decision which aligns with their values. This study aims to develop a decision aid to support shared decision making between patients and dentists regarding risk-based dental recall intervals and to understand the practical and logistic considerations of running a randomised trial of a decision aid for dental recall intervals in general dental practice.

This project has three parts:

Part 1 is a qualitative study which will describe how decisions regarding dental recall interval are currently made, and explore the barriers and facilitators to the implementation of risk-based recall intervals in general dental practice. 20 general dental practitioners (GDPs) and 20 patients will participate in semi-structured telephone interviews.

Outputs: Data will be mapped through the capability, opportunity, motivation-behaviour (COM-B) model to the Behaviour Change Wheel. This will identify behaviours for change which to be prioritised in the design and testing of the decision aid. The findings will also include a list of 'frequently asked questions' will inform the domains of the decision aid.

Part 2 involves the development of a decision aid to support shared decision regarding dental recall interval. The development process will follow published guidelines and involve substantial user engagement.

Output: a paper-based decision aid to support co-production of dental recall interval suitable for chairside use in general dental practice.

Part 3 is a mixed-method feasibility study examining the practical and logistical considerations of running a randomised trial of a chairside decision aid for dental recall interval in general dental practice. A quantitative before-and-after study with a stepped wedge design will be used to explore potential recruitment rates, and to test a prototype Decisional Quality Measure. 100 dental patients will be recruited to take part in this study. This will be supported by qualitative interviews with GDPs (n=10) and patients (n=20) which will be undertaken after they have used the decision aid. The findings will be synthesised to assess the appropriateness, acceptability and utility the aid, and to inform the design of a larger pilot study ahead of a full randomised trial of the aid in general dental practice.