Decision aids against overuse of orthodontic services?

Spassov, Alexander and Braun, Bernard and Carceva-Salja, Sofija and Bettin, Hartmut and Pavlovic, Dragan (2017) Decision aids against overuse of orthodontic services? Journal of Orthodontics, 44 (1). pp. 70-71. ISSN 1465-3125, 1465-3133

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Development and evaluation of a patient decision aid
for young people and parents considering fixed
orthodontic appliances by Marshmann et al. (2016).
J Orthod. 43:276-287.
The development of the first fixed appliance decision
aid (FADA) may be an enormous advancement in
improving the quality of orthodontic care (Marshmann
et al. 2016). The importance of the work arises especially
from the fact that decision aids may facilitate the shared
decision-making process by means of providing up-todate scientific evidence on benefits and harms if presented in an appropriate format and at a right time
point during the patient-physician communication.
That is to say, through better information and better
understanding, FADA may strengthen patient autonomy
which is the fundament of bioethics and professional
As we read through the study however, we have
certain doubts that authors conclusion that the FADA
provides patient-relevant information, a hallmark of
decision aids, probably cannot be drawn from this
study. According to the criteria of the International
Patients Decision Aids Standards (IPDAS), relevant treatment options presented in the decision aids have to
include also the ‘comprehensive, critically appraised,
and up-to-date syntheses of the scientific evidence’
(IPDAS 2012). However, according to the section
Methods of the study, the authors did not conduct any
systematic review and critical appraisal of the available
evidence to inform the content of FADA. For example
the FADA’s content on root resorption, white spot
lesions and patient experience were supported by only
few selected single studies without clear selection criteria
(Marshmann et al. 2016). Yet if the FADA fails to include
some up-to-date and critically appraised evidence it
may misinform patients (ethical dimension), cause
unnecessary treatments (quality of care dimension) and
thus resulting in more harm than good (Montori et al.
2013). We are aware of the difficulties associated with
providing up-to-date scientific evidence for available
treatment options, often limited funding, time consuming appraisal of literature, or low quality of available systematic reviews, just to mention a few. However, those
limitations should be explicitly mentioned in the study
so readers may be aware of them when drawing conclusion from the results. Also, strategies have been
suggested to overcome the limitations of traditional
decision aids and they could be useful in developing
the FADA (Agoritsas et al. 2015).
To conclude, the authors made a first and probably
most important step toward strengthening patient
autonomy, given that the content and the presentation
of the FADA is truly evidence-based. In orthodontic
care, where probably misinformation and subsequent
excessive overtreatment are common (Ackermann
2010; Spassov et al. 2015), decision aids may be one valuable strategy to overcome those problems that may
causes unnecessary harm and costs to patients and

Item Type: Article
Subjects: Medical and Health Sciences > Other medical sciences
Divisions: Faculty of Medical Science
Depositing User: Sandra Atanasova
Date Deposited: 03 Sep 2019 08:14
Last Modified: 03 Sep 2019 08:14

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