Impact of Providing Patients with Internet Guidance on Clinical Decision-Making and Health Care Outcomes

Abstract

The majority of Australians who underwent third molar extractions (TME) over a 12-month period received multiple TME with no impact upon their short-term self-rated oral health—a finding from our analysis to the Australia’s 2013 National Dental Telephone Interview Survey. The number of TME was associated with being dentally insured suggesting a possible over-management. Additionally, our finding questioned the use of age as a justification for prophylactic TME. Sine evidence does not support the prophylactic TME and those patients are not adequately informed, emailing patients a pre-consultation educational resources might be beneficial. A randomized control trial (RCT) was conducted to identify whether this intervention could improve TME knowledge and consequently participation in shared decision-making (SDM), dental anxiety and health outcomes. High quality resources were provided as a RCT intervention after conducting a quality and readability assessment for TME online resources using criteria and tools developed for this purpose. The observed variability in TME information quality across websites might question the patients’ ability to get high quality information since our participants were unable to recognize online information quality seals. The majority of our participants were internet-ready with no impact upon their TME knowledge. The internet-ready phenomenon was explained by patients’ preference for an active decisional control. Although our RCT participants were community dental patients seeking public sector treatment, they preferred participation in decision-making. Being a female patient and/or having higher education was associated with an active decisional control preference. This might improve clinicians’ sensitivity to patients’ decisional control role. Preference for involvement in decision-making was associated with a better oral health-related quality of life (QoL) suggesting the benefit for enhancing patients’ involvement in SDM. The researcher explored and modeled how third molars (TMs) experience might impact upon QoL and how QoL domains interact using a qualitative real-time twitter data. This approach showed that the available QoL measures have conceptual limitations in capturing these impacts with wide instrument to instrument variation. QoL domains identified from the Twitter study might be used to develop a new QoL measure for TMs. Although the researcher found that patients’ TMs knowledge was associated with SDM, the intervention provided did not improve patients’ knowledge and therefore it did not improve SDM and consultation outcomes. The lack of efficacy of the intervention provided might be attributed to the wide prevalence of low educational attainment that might limit information uptake. More research is needed to develop information resources for low literacy patients. Our intervention did not increase dental anxiety however, both groups reported high levels of dental anxiety which needs clinicians’ attention. This research contributes to clinical practice by improving patient-clinician communication and TME decision-making. It contributes to patient education theory by revealing gaps in online information quality and information seeking behavior. It contributes to the field of health service quality by revealing the association between involvement in SDM and oral health-related QoL. Arriving at these findings was enabled by using different study designs and mixed research methods. This research suggested several future research opportunities.