ArticleSpecial care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry
Involving Independent Mental Capacity Advocates (IMCAs) in Dental Care Decision-Making: A Qualitative Exploration of Dentists' Experiences in England and Wales.
Article in Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDelivering dental care to individuals who lack decision-making capacity involves complex ethical, legal, and clinical considerations. In England and Wales, Independent Mental Capacity Advocates (IMCAs) are required to support decisions about 'serious medical treatment', a concept given only broad definition in law. While Special Care Dentistry frequently involves patients with cognitive impairments, little is known about how dentists engage with advocates in treatment decision-making.
objectiveTo explore dentists' experiences of appointing and working with advocates in dental care decision-making and to understand the reasons for advocacy involvement and its perceived value.
methodsSemi-structured one-to-one online interviews were conducted with nine dentists. Data were generated and analyzed concurrently using a maximum variation sampling approach and Reflexive Thematic Analysis. Interviews were audio-recorded, transcribed verbatim, and initially coded independently by four researchers. Through iterative discussion, codes were refined and organized into themes.
resultsFive themes were generated. Dentists demonstrated a strong commitment to optimizing patient capacity and delivering person-centered care. However, there was substantial variation regarding the interpretation of 'serious medical treatment' in the dental context. Decisions to involve IMCAs were often based on treatment modality rather than individual patient impact. Dentists reported that advocates' involvement rarely altered proposed treatment plans and felt this was frequently associated with delays, which were perceived as counterproductive to patient care. DISCUSSION: Uncertainty surrounding the definition of 'serious medical treatment' contributes to inconsistent advocate involvement and may limit the effectiveness of advocacy. A broader, individualized understanding of seriousness, incorporating clinical, functional, and personal consequences, is needed.
conclusionClearer guidance and earlier, more meaningful advocate involvement are needed to support consistent, timely, and genuinely person-centered dental decision-making for patients without friends or family to support them.
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