치과 영역에서의 공유의사결정 실천: 치주질환을 중심으로

Abstract

Purpose: This study aimed to develop and evaluate a structured shared decision-making (SDM) protocol tailored for patients with periodontally compromised teeth. Given the complexity and irreversibility of dental treatment decisions, particularly those involving tooth preservation or extraction, this protocol is designed to align clinical judgment with patient values through a standardized approach applicable to real-world dental settings. Current Concepts: Although various treatment options are available in dental care, clinical decisions have traditionally relied heavily on the clinician's judgment and experience, often limiting meaningful patient involvement. This issue is particularly pronounced in the management of periodontally compromised teeth, where outcomes are highly variable and preference-sensitive. While recent initiatives introducing decision aids have improved information delivery, most remain one-directional and lack a structured protocol to facilitate interactive SDM. To address this gap, this study introduces a 3-step SDM model based on Elwyn's 3-talk approach, integrating web-based decision aids with structured training to support patient-centered, preference-driven treatment planning. Discussion and Conclusion: The proposed SDM protocol demonstrated practical utility in the management of complex periodontal treatment planning. Structured conversations and visual decision aids enhanced patients' understanding and reduced uncertainty, enabling informed decisions aligned with their values. Nonetheless, barriers such as limited consultation time, provider perceptions, and variability in patient health literacy remain significant implementation challenges. Overcoming these barriers will require a team-based approach, customized decision-support tools, and supportive policies. This protocol offers a scalable and feasible model for incorporating SDM into dental practice and may strengthen patient engagement, reduce decisional regret, and promote tooth-preserving care.