title: Patients' preferences for selective versus complete excavation: A mixed-methods study.
abstract: OBJECTIVE
  Despite increasing evidence supporting selective caries tissue removal, the technique is not adopted by most dentists, one possible reason being that patients might reject it. We aimed to assess patients' preferences for selective versus complete excavation, and to identify predictors of this preference.
  
  
  METHODS
  A sequential mixed-methods approach was taken. First, semi-structured focus group discussions on two convenience samples were performed. Verbatim transcripts were evaluated using content-analysis to inform quantitative study design. The subsequent survey employed convenience, snow-ball and deviant-case sampling, yielding 150 respondents. The relevance of treatment attributes (risks of nerve damage, root-canal treatment, recurrent caries, restorative complications, treatment costs, aesthetic consequences) on patients' treatment preferences was measured using case-vignettes. Dental experience and anxiety as well as patients' personality and socio-demographic details were recorded. Association of predictor variables (age, gender, education, partnership status, personality items, dental experience, anxiety) with treatment preference was assessed using regression analysis.
  
  
  RESULTS
  Focus group participants perceived complete excavation as reliable, but feared endodontic treatment. The vast majority of survey respondents (82.7%) preferred complete over selective excavation. The preference for selective excavation was significantly increased in patients with an emotionally stable personality (p<0.001), university entrance degree (p<0.001), none or little dental anxiety (p=0.044), few dentist changes in the past (p=0.025), and who accepted that sealed lesions could progress (p<0.002).
  
  
  CONCLUSIONS
  Treatment attributes, socio-demographic characteristics, personality and dental experiences shape patients' preference towards caries excavation.
  
  
  CONCLUSIONS
  Clinical decision-making regarding carious tissue removal might be affected by dentists on both an informative and an empathic level.
authors.affiliation: Department of Operative and Preventive Dentistry, Charité University of Berlin, Germany. Electronic address: falk.schwendicke@charite.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Schwendicke
authors.affiliation: Department of Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mostajaboldave
authors.affiliation: Department of Medical Psychology, Charité University of Berlin, Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Otto
authors.affiliation: Department of Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Christof E
authors.initials: CE
authors.lastname: Dörfer
authors.affiliation: Department of Medical Psychology, Charité University of Berlin, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Burkert
mesh_terms: D000328:Adult; D003731:Dental Caries / Q000628:therapy*; D003737:Dental Cavity Preparation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003789:Dental Pulp Exposure / Q000517:prevention & control; D003793:Dental Restoration, Permanent; D004955:Esthetics, Dental / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D012390:Root Canal Therapy / Q000191:economics / Q000379:methods; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Dental anxiety; Endodontic treatment; Mixed methods; Patient preferences; Selective caries removal; Treatment decision