Factors which determine the referral of potentially malignant disorders by primary care dentists
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In: Journal of Dentistry, Vol. 38, No. 7, 07.2010, p. 569-578.
Research output: Contribution to journal › Article › peer-review
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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 -