TY - JOUR

T1 - Factors which determine the referral of potentially malignant disorders by primary care dentists

AU - Brocklehurst, Paul R

AU - Baker, Sarah R

AU - Speight, Paul M

N1 - Copyright 2010 Elsevier Ltd. All rights reserved.

PY - 2010/7

Y1 - 2010/7

N2 - OBJECTIVES: The detection of potentially malignant disorders (PMD) is of paramount importance, yet few studies have examined what factors or cues primary care dentists (PCDs) take into account when diagnosing and referring PMD. The objective of this study was to determine what cues PCDs use when making a decision to refer PMD to secondary care.METHODS: Ten clinical vignettes were presented to PCDs using a website in the public domain. Five vignettes represented PMD and five represented benign conditions. Participants were asked to provide a differential diagnosis, a referral decision and score 12 supplied cues based on their importance in this decision. Optimal data analysis was then used to determine which of the 12 cues were significant at predicting the participants' referral decision.RESULTS: 147 participants responded and the number of accurate diagnoses for the PMD group ranged from 46.3 to 79.5%, whilst the number of correct referral decisions ranged from 77.6 to 86.9%. The number of accurate diagnoses and referral decisions in the benign group ranged from 63.0 to 89.0% and 40.1 to 71.9% respectively. Risk factors were statistically significant in their ability to predict a referral decision in both groups, but overall there appeared to be a lack of discrimination in the referral decision.CONCLUSION: The results show that PCDs use a range of cues in the decision making process and suggest that if they are at all in doubt or are faced with worrying cues, their default position is to refer. Whilst this is reassuring, greater education of PCDs and standardised criteria are essential to avoid over-referral.

AB - OBJECTIVES: The detection of potentially malignant disorders (PMD) is of paramount importance, yet few studies have examined what factors or cues primary care dentists (PCDs) take into account when diagnosing and referring PMD. The objective of this study was to determine what cues PCDs use when making a decision to refer PMD to secondary care.METHODS: Ten clinical vignettes were presented to PCDs using a website in the public domain. Five vignettes represented PMD and five represented benign conditions. Participants were asked to provide a differential diagnosis, a referral decision and score 12 supplied cues based on their importance in this decision. Optimal data analysis was then used to determine which of the 12 cues were significant at predicting the participants' referral decision.RESULTS: 147 participants responded and the number of accurate diagnoses for the PMD group ranged from 46.3 to 79.5%, whilst the number of correct referral decisions ranged from 77.6 to 86.9%. The number of accurate diagnoses and referral decisions in the benign group ranged from 63.0 to 89.0% and 40.1 to 71.9% respectively. Risk factors were statistically significant in their ability to predict a referral decision in both groups, but overall there appeared to be a lack of discrimination in the referral decision.CONCLUSION: The results show that PCDs use a range of cues in the decision making process and suggest that if they are at all in doubt or are faced with worrying cues, their default position is to refer. Whilst this is reassuring, greater education of PCDs and standardised criteria are essential to avoid over-referral.

KW - Adult

KW - Age Factors

KW - Alcohol Drinking

KW - Cues

KW - Decision Making

KW - Dental Records

KW - Dentists

KW - Diagnosis, Differential

KW - Female

KW - Food Habits

KW - Forecasting

KW - Humans

KW - Male

KW - Medical History Taking

KW - Middle Aged

KW - Mouth Neoplasms

KW - Precancerous Conditions

KW - Primary Health Care

KW - Referral and Consultation

KW - Risk Factors

KW - Sensitivity and Specificity

KW - Smoking

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/j.jdent.2010.04.008

DO - 10.1016/j.jdent.2010.04.008

M3 - Article

C2 - 20417679

VL - 38

SP - 569

EP - 578

JO - Journal of Dentistry

JF - Journal of Dentistry

SN - 0300-5712

IS - 7

ER -