title: Clinical decision making for a tooth with apical periodontitis: the patients' preferred level of participation.
abstract: BACKGROUND
  To effectively engage patients in clinical decisions regarding the management of teeth with apical periodontitis (AP), there is a need to explore patients' perspectives on the decision-making process. This study surveyed patients for their preferred level of participation in making treatment decisions for a tooth with AP.
  
  
  METHODS
  Data were collected through a mail-out survey of 800 University of Toronto Faculty of Dentistry patients, complemented by a convenience sample of 200 patients from 10 community practices. The Control Preferences Scale was used to evaluate the patients' preferences for active, collaborative, or passive participation in treatment decisions for a tooth with AP. Using bivariate and logistic regression analyses, the Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to the Control Preferences Scale questions to understand the influential factors (P ≤ .05).
  
  
  RESULTS
  Among 434 of 1,000 respondents, 44%, 40%, and 16% preferred an active, collaborative, and passive participation, respectively. Logistic regression showed a significant association (P ≤ .025) between participants' higher education and preference for active participation compared with a collaborative role. Also, immigrant status was significantly associated with preference for passive participation (P = .025).
  
  
  CONCLUSIONS
  The majority of patients valued an active or collaborative participation in deciding treatment for a tooth with AP. This pattern implied a preference for a patient-centered practice mode that emphasizes patient autonomy in decision making.
authors.affiliation: Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada. Electronic address: amir.azarpazhooh@dentistry.utoronto.ca.
authors.forename: Amir
authors.initials: A
authors.lastname: Azarpazhooh
authors.affiliation: Discipline of Prosthodontics, Faculty of Dentistry, University of Toronto, Ontario, Canada.
authors.forename: Thuan
authors.initials: T
authors.lastname: Dao
authors.affiliation: Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.affiliation: Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Faiza
authors.initials: F
authors.lastname: Chaudry
authors.affiliation: Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rafael
authors.initials: R
authors.lastname: Figueiredo
authors.affiliation: Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.affiliation: Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shimon
authors.initials: S
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003657:Decision Making; D019094:Dental Prosthesis, Implant-Supported / Q000523:psychology; D003812:Dentist-Patient Relations; D003830:Denture, Partial, Fixed / Q000523:psychology; D003832:Denture, Partial, Removable / Q000523:psychology; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D010485:Periapical Periodontitis / Q000523:psychology / Q000628:therapy*; D026684:Personal Autonomy; D012390:Root Canal Therapy / Q000523:psychology; D012959:Socioeconomic Factors; D014081:Tooth Extraction / Q000523:psychology; D055815:Young Adult
keywords: Apical periodontitis; dentist-patient relations; patient preference; personal autonomy; principle-based ethics; shared decision making