Patient Preferences and Expectations
For treatment evaluation, patient self-perceived health and treatment satisfaction are used to measure outcome effectiveness. These values are usually referred to as patient-based measures because they are based on patients’ treatment perceptions.1-3 In the last decade, more studies have measured patients’ perceptions of oral prostheses, including implant-supported overdentures, rather than solely considering clinical outcomes such as survival rates of implants and anatomical changes. While satisfactory clinical outcomes are important factors in the evaluation of the effectiveness of implant overdentures, these outcomes involve only the technical aspect of the prostheses. Consequently, they do not reflect the patient’s opinion and degree of satisfaction with the treatment. This is an important aspect to consider, as edentulism is a chronic condition and therapy is palliative, aimed at improving function and quality of life.1
The patient’s point of view is important in light of reported results that show a poor association between patients’ satisfaction with their prosthesis and the clinical qualities of the prosthesis as assessed by the clinicians.4-9 For example, reports show that, although there is a weak association between patient satisfaction and clinical evaluation of the denture fit, there is a stronger association between patients’ perceived masticatory ability and satisfaction with their prostheses.9 Similar findings suggest that laboratory results of masticatory efficiency, rather than patient satisfaction ratings, should determine the presence of denture problems. Other findings have suggested that masticatory efficiency tests were poor predictors of patients’ choice of prostheses; however, satisfaction ratings of different treatment aspects, such as comfort and stability, were associated with patient preferences. Furthermore, most studies that attempted to correlate patient satisfaction ratings of treatment and the clinician’s opinion of the same treatment have found these correlations to be poor8; also, clinicians’ ratings were not predictive of patient satisfaction. These discrepancies were attributed to the fact that clinicians usually apply predetermined criteria to their treatment evaluation that do not take into consideration the behavioral and psychosocial impact of therapy. For these reasons, there has been considerable interest in understanding and evaluating patients’ preferences, expectations, and perceived ability to function with oral prostheses.
There is an increased appreciation among the medical community for the need to incorporate patient preferences into the medical decision-making process. This necessity came about as a result of the dramatic shift toward patient-centered care, in which health care is suited to patients’ long-term needs.10 Health care providers’ interest has broadened beyond survival into the areas of psychosocial function and perceived health; in fact, it is believed that when patients participate in decisions regarding their health care, they tend to respond better to treatment.11 Patient-based measures, such as quality of life, become an important outcome of treatment.1
Better understanding of patient preferences and the possible consequence of treatment satisfaction can be important in predicting patient behaviors, including demand for particular services.
It is possible for patients to prefer one form of therapy over another, not because they believe the outcome is more favorable, but instead because they find the process to be more acceptable. For example, patients may prefer to receive conventional dentures rather than implant-supported prostheses because of a fear of surgery; the decision is based on fear rather than a belief that conventional dentures provide the same stability as do implant-supported overdentures. Therefore, the term preference should be used with a clear understanding of what the prosthesis does and does not include. 12 Preference should be distinguished from what the patient desires or wants because of reasons not necessarily related to the treatment. In clinical practice, associated preferences should be based on estimated risks and benefits of proposed treatments with known efficacy. Patients do not make decisions based solely on choices that fulfill an immediate or temporary need. This can be remedied through proper patient-clinician communication, including informing patients of possible outcomes of all available therapies; ideally then patients use this information in the decision-making process.
Incorporation of patient preferences in decision making is not uncommon in medicine. Patient preferences have been evaluated in studies of cancer,13 arthritis,14 and diabetes.15 Results indicate that, given sufficient information, patients were able to make a decision regarding their choice of treatment. It also has been reported that patients who chose their treatment reported less pain compared to other patients who were not given this option.16
In dentistry, however, the role of patient preferences is rarely evaluated. Nevertheless, it is an important issue, especially in cases of oral rehabilitation in which patients are expected to live with the treatment for long periods of time.2 In addition, patients’ perceptions may influence their level of satisfaction with the prostheses and consequently impact quality of life.
In a within-subject cross-over clinical trial16 comparing fixed and removable implant-supported prostheses, 15 patients were randomly divided into two groups. One group received a fixed prosthesis while the other group received a removable prosthesis. After a 2-month period of adaptation, the patients rated their prostheses. The current prostheses were then replaced with one of the other type so that each patient could rate both types of prosthesis, and the procedure was repeated. At the end of the trial, patients were given the opportunity to choose their preferred prostheses. Eight patients preferred the fixed prostheses and the other seven preferred the removable prostheses. Those patients who chose the fixed prostheses indicated that the most important factor governing their choice was stability; those who preferred the removable prostheses indicated that ease of cleaning was the most important factor. Eighteen months later all patients reported to be very satisfied with their choice, and 69% of the subjects gave the same reasons that they had given earlier for their choice. These findings suggest that patients’ preferences were not arbitrary, but instead reflected what they perceived to be important characteristics of the prostheses. Nevertheless, patients in this study tried both treatments and their choice was made based on their own experience In clinical practice, patients usually do not have such an opportunity, and preference for one form of treatment is determined by their current oral status and possible deficiencies that may exist in their dentures.
The association />