Patient Preferences for Treatment of Mandibular Fracture

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Mandibular fracture is one of the most common orofacial injury for minority individuals. A developing body of literature notes that patient involvement in treatment decisions may increase satisfaction with outcomes and, ultimately, promote adherence to medical instructions. This has been especially important for treatments that produce side effects that significantly reduce quality of life for patients. While patient choice is not an option for management of some mandibular fractures where the severity of the injury dictates the most applicable treatment modality, for many either fractures surgical (Rigid Internal Fixation) or nonsurgical treatment (Maxillomandibular fixation) is possible. The objective of this application is to advance the profession's understanding of patient preferences for surgical versus nonsurgical treatment and how knowledge of potential pain-related suffering and functional limitations associated with treatment may affect patients' preference for treatment. Our central hypothesis is that patient characteristics, perceptions about pain and functional limitations, and prior experience with surgery and orofacial injury will influence the patient's preference for treatment. We wish to extend an ongoing research study, "Physical, Psychosocial and Economic Impact of Orofacial Injury" funded by the National Institute for Dental and Craniofacial Research (number DE/RR10598). To accomplish our current objectives, four specific aims will be pursued. Specific Aim 1: Determine patient understanding of risk benefit description and the decision processes that patients pursue when making decisions regarding selection of treatment to repair a mandibular fracture. Specific Aim 2: Determine the impact of patient characteristics, past treatment experience, and differences of pain and functional limitation perception on treatment choice as evidenced by their responses to the three preference-based measures Standard Gamble, Time Tradeoff and Willingness to Pay. Specific Aim 3: Determine the stability of the patient's preference for treatment over time, that is, as the patient moves farther from the event that caused the mandibular fracture or removal of third molars. Specific Aim 4: Integrate the information on patient preferences into a cost utility analysis of Maxillomandibular fixation versus Rigid Internal Fixation using cost and problem prevalence data from the RCT parent study. This study will be the first study in orofacial injury that considers how a sociodemographically disadvantaged sample values health states and integrates such perceptions into decision-making, providing guidance for clinicians in assisting patients with informed consent.