Tx Plan-Risk Assessment, Prognosis-Pafford

Question 1

Why do we formulate Tx Plans? (rationale)

Answer 1

• Vision for future outcome
• Roadmap on how to get there
• Organized/efficient delivery of care
• Patient engagement
• Patient education
• Evidence of professional competence
• Risk management benefits
• “Good practice”

Question 2

Guild Model

Answer 2

• Traditional Stepwise approach
• Dentist is guided by altruistic motivation to do what is best for the patient
• does not encourage:
  
  • patient autonomy (undermines autonomy)
  • patient-centered tx planning
• Source of authority= profession (paternalism)
• dentist determines patient need

Question 3

Guild Model: Steps

Answer 3

• eval patient
• develop diagnosis or problem list
• Plan a series of treatments

Question 4

Why does the guild model fall short?

Answer 4

• Dentist takes problem-focused approach
  
  • has pain so dentist evals chief complaint and makes immediate recommendation about what should be done
  • clear diagnosis is not made
    
    • patient is not properly educated
    • sometimes not given options
  • true informed consent is compromised
• Tx plan scope is too narrow
  
  • used properly, dentist considers all dx and tx options
  • does not compare options

Question 5

Ozar and Sokol

Answer 5

• Stepwise approach to ethical decision making

Question 6

Ozar and Sokol: Questions to ask when formulating tx plans

Answer 6

• Identify the alternatives:
  
  • What choices are available? What might be their outcomes?
  • What is the probability of each outcome
• Determine what is:
  
  • professionally at stake
    
    • What are the implications of each alternative from a professional perspective?
  • ethically at stake:
    
    • “ ” from a broader ethical perspective
• Rank alternative by professional and ethical issues at stake and expected outcomes
• Determine what ought to be done and do it
  
  • (includes judging and choosing)

Question 7

What are Ozar’s Models of the Doctor-patient Relationship?

Answer 7

• Guild Model
• Agent Model
• Commercial Model
• Interactive model

Question 8

Ozar’s: Interactive Model

Answer 8

• most desirable
• Relationship is based on mutual respect
  
  • equal moral standing
• dentist and patient are equal partners in decision making

Question 9

How are doctor and patient equal parters in 3 aspects?

Answer 9

• Both have:
  
  • equal standing and respect for other
  • values
  • involved in decision-making

Question 10

Why do Dentists Disagree on Treatment Planning?

Answer 10

• Individualism
  
  • “I know what is best for my patients”
• Empiricism
  
  • “It works best in my hands”
• Disagreement over the diagnosis
• Lack of Risk Assessment
• Uncertain about prognosis
• Limited availability/use of Outcomes Determination

Question 11

Evidence Based Dentistry

Answer 11

• Tx plan decisions based on:
  
  • dentists expertise
  • patient’s needs
  • best/most relevant published research
    
    • systemic reviews

Question 12

Systemic Reviews

Answer 12

• best quality evidence for dentists

Question 13

Define: at risk

Answer 13

• its who have the innate predisposition or engage in behaviors that promote a disease or condition

Question 14

Define: Risk indicators

Answer 14

• identifiable conditions
  
  • associated w/a higher probability of a disease occurring
  • not always the cause

Question 15

Define: Risk factors

Answer 15

• subset of risk indicators
• can demonstrate a biologic link b/w factor and disease

Question 16

Define: Immutable risk factors/indicators

Answer 16

• the risk factors/indicators that can’t be changed
  
  • age
  • socioeconomic status
  • fluoride hx

Question 17

Define: mutable risk factors/indicators

Answer 17

• the risk factors/indicators that can be changed
  
  • diet
  • oral self care
  • smoking
  • poor contoured restorations

Question 17

Risk Assessment helps to:

Answer 17

• identify the need for counseling patients, spouse, or offspring about heritable conditions
• eliminating recognized causes of oral disease when patient is known to be at risk
• xx

Question 18

Define Prognosis:

Answer 18

• estimation of the likelihood of a favorable outcome for a disease
  
  • likelihood for success of a tx
  • estimated recovery from a condition

Question 19

Prognosis

Answer 19

• expressed in general terms:
  
  • excellent, good, favorable, fair, guarded, unfavorable, poor
• can be related to risk
• several issues can influence the prognosis
  
  • might not be risk indicators
    
    • ex: skill of the dentist
      
      • patients motivation

Question 20

define outcomes:

Answer 20

• specific, tangible results of treatment
• linked to risk and prognosis

Question 21

Define outcomes expectations:

Answer 21

• the results that a patient and practitioner expect to receive as a result of treatment

Question 22

Define outcomes measures:

Answer 22

• tools to assess the impact of treatment
• info is useful in effective clinical tx decisions