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An exploratory qualitative study of patients’ perceptions of material risks for orthognathic surgery.

Trial Status: Open

Orthognathic surgery is performed to change the position of the jawbones in order to correct a significant dental malocclusion, which is beyond the scope of conventional orthodontic (brace) treatment. Patients present with concerns regarding their facial appearance as well as functional problems. The aims of surgery are to improve facial appearance as well as physical and mental health, resulting in an overall improvement in the quality of life.

Orthognathic surgery is an elective procedure, and as with any surgical intervention, have risks as well as benefits. Individuals undergoing this type of surgery need to be involved in the decision-making process for several reasons. Firstly, there is a move away from medical paternalism towards more patient-centred treatment. Secondly, patient involvement in the decision-making process has been shown to improve patient satisfaction and to help manage expectations. Thirdly, patients need to be aware of the risks, benefits and alternatives of treatment in order for them to provide informed consent.

Following the judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11, paragraph 87 it was highlighted a patient has to be informed of what they would consider to be a material risk:
‘The doctor is therefore under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.

‘The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.’

This would suggest that patients need to know the material risks of jaw surgery, then decide on the amount of risk they are willing to take i.e. is that risk of the event happening enough to make them decline surgery. In other words, the surgeon and patient need to have a thorough discussion of the risks of surgery that allows the surgeon to understand what the material risks are for a particular patient, and then to give them the information in order to be able to agree to or decline surgery.

This research aims to lay the groundwork for a structured approach for orthognathic surgeons in carrying out conversations about risks and taking consent prior to surgery. By carrying out qualitative research, through interviews, it will explore patients’ perceptions of the risk involved, their attitudes towards taking risks and which risks are particularly salient to them. We will also elicit the experiences and perspectives of oral and maxillofacial surgeons.

The study will be divided into two parts. The first will involve carrying out semi-structured interviews on patients to identify what risks of surgery they were aware of and explore the salience of particular risks to them in context of their life and work? the data will be analysed using a thematic approach. The second part of the study will determine the weightings of the most common risks as perceived by the patients and by clinicians.