Preradiation dental decisions in patients with head and neck cancer

Abstract

This thesis presents a series of studies that investigated preradiation dental decision making in patients with head and neck cancer. In Chapter 1, it is ascertained that in view of the risk for oral sequelae resulting from high-dose radiotherapy, special attention to preradiation dental planning appears critical. Each case must be managed individually on the basis of the patient's needs, the status of the tumor, and the risks for dental health in irradiated tissues; a single-formula approach for all patients is contra-indicated. In accordance with the evidence-based approach that forms the basis of the healthcare paradigm of this new millennium, the main subject of this thesis is to develop and to test a decision support system, in order to enhance dental decision-making in patients with head and neck cancer. More specifically, studies were conducted to:

(1) Identify the decision dilemma and perform a clinical decision analysis; (2) Analyze the decision policies of clinicians familiar with and experienced in preradiation dental screening in order to describe how dental- and radiotherapy-related risk factors influence their decision-making; (3) Propose a method for judgment analysis, in order to identify the characteristics of individual judgment policies of dental clinicians with respect to the prophylactic extraction of teeth; (4) Develop and test "SCREDENT," a system for dental decision support in patients with head and neck cancer.

In the studies underlying this thesis, three different approaches to analyzing judgment and decision-making were used: normative, descriptive, and contextual. These approaches to analyzing judgment and decision-making relate to decision strategies.