Patient Preferences for Treatment of Mandibular Fracture

下颌骨骨折是少数民族最常见的口腔颌面损伤之一。一系列发展中的文献指出，患者参与治疗决策可能会增加患者对结果的满意度，并最终促进对医疗指导的遵守。这对于产生副作用的治疗尤其重要，这些副作用会显著降低患者的生活质量。虽然患者的选择不是治疗某些下颌骨骨折的一种选择，因为损伤的严重程度决定了最适用的治疗方式，但对许多骨折来说，手术治疗(坚固内固定)或非手术治疗(上颌骨固定)是可能的。这一应用的目的是促进该行业对患者对手术治疗和非手术治疗的偏好的理解，以及与治疗相关的潜在疼痛相关痛苦和功能限制的知识如何影响患者对治疗的偏好。我们的中心假设是，患者的特征、对疼痛和功能限制的看法以及先前的手术和口腔面部损伤经验将影响患者对治疗的偏好。我们希望扩展一项正在进行的研究，即由国家牙科和颅面研究所(编号DE/RR10598)资助的“口腔面部损伤对身体、心理社会和经济的影响”。为了实现我们目前的目标，我们将实现四个具体目标。具体目标1：确定患者对风险效益描述的理解，以及患者在做出关于修复下颌骨骨折的治疗选择的决定时所遵循的决策过程。具体目标2：确定患者的特征、过去的治疗经验以及疼痛和功能限制知觉的差异对治疗选择的影响，通过他们对标准赌博、时间权衡和支付意愿这三个基于偏好的措施的反应来证明。具体目标3：确定随着时间的推移，患者对治疗的偏好的稳定性，即患者距离导致下颌骨折或拔除第三磨牙的事件越远。具体目标4：将有关患者偏好的信息整合到上颌骨固定与坚固内固定的成本效用分析中，使用来自RCT父母研究的成本和问题流行率数据。这项研究将是第一项关于口腔面部损伤的研究，该研究考虑了社会人口学上处于不利地位的样本如何评估健康状态，并将这种感知整合到决策中，为临床医生提供指导，帮助患者获得知情同意。

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.