Supporting dental treatment decisions for people living with dementia

Abstract

Background: Making dental treatment decisions can be complex for people living with dementia (PLwD), their carers and dentists. There is limited research exploring how PLwD, their carers or dentists may be supported with dental treatment decision-making. Aim: The work presented in this thesis aimed to support the collaborative production of an intervention to support PLwD, their carers, and dentists with dental treatment decision-making. Methods: Four related projects comprise this thesis: Project 1 was a systematic review that explored the effectiveness of existing interventions supporting healthcare decision-making for PLwD. Projects 2 and 3 used qualitative interviews to explore the experiences of dentists, PLwD and carers regarding dental treatment decision-making. Constructivist grounded theory methods, where data were simultaneously generated and analysed, were used to develop an understanding of each group's experiences and how dentists approach treatment decision-making for PLwD. Project 4 used co production where PLwD, carers, dental team members and other stakeholders worked together to develop a prototype intervention to support PLwD, carers and dentists with dental care decision making. Results: No interventions were identified that were effective in supporting PLwD with healthcare decisions, including dental care (Project 1). Despite seeking to provide individualised care, dentists reported specific approaches to decision-making for PLwD which focused heavily on biomedical aspects of care, such as medical risk or benefit (Project 2). PLwD and carers explained they wished to be understood and more involved in dental treatment decision-making (Project 3). A series of workshops and separate interactions with PLwD and a dental team led to the co-production of the Dental Decisions Tool, which may support patient and carer involvement in dental treatment decisions (Project 4). Summary: Informed by qualitative research, the Dental Decisions Tool was co-produced to gather information on PLwD’s preferences and values for care, and to support PLwD, carers and dentists with dental treatment decision-making. Once completed, the Dental Decisions Tool may also support best interest decision-making for people lacking the capacity to consent for dental treatment. Further research is needed to explore the acceptability, suitability, and effectiveness of this tool.