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. 2025 Apr 16;52(7):960–970. doi: 10.1111/jcpe.14166

Patient‐Centred Preferences for Autonomy and Information‐Seeking Among Periodontal Patients in Dental Decision Making

Ji‐Young Jung 1,2, Kyung‐A Ko 1,2, Franz J Strauss 3,4, Jae‐Hong Lee 5,6, Jun‐Hewk Kim 7, Jung‐Seok Lee 1,2,✉
PMCID: PMC12176460  PMID: 40237198

ABSTRACT

Background and Aim

Managing periodontal disease often involves complex decisions involving multiple treatment options, and patient autonomy significantly influences this decision‐making process. This study aimed to characterise the autonomy and information‐seeking preferences among patients diagnosed with stage III/IV periodontitis, and to identify the factors influencing these preferences.

Materials and Methods

The survey included 96 patients diagnosed with periodontal disease, all of whom underwent periodontal treatment or tooth extraction between May 2021 and February 2022. Participants completed a self‐administered questionnaire incorporating the Autonomy Preference Index (API) to assess their decision‐making and information‐seeking preferences, along with demographic information, using a 5‐point Likert scale.

Results

Decision‐making preferences were centrally distributed, with a score of 2.87 ± 0.47 (mean ± SD), indicating that most periodontal patients favoured a collaborative decision‐making model. In contrast, information‐seeking preferences were skewed, with a strong concentration towards the higher end of information preferences; the score was 4.55 ± 0.08. Lower age (p = 0.008) was associated with a preference for greater autonomy, while the financial burden (p = 0.034) was linked to reduced information‐seeking preferences. Patients' autonomy remained relatively consistent across different periodontal clinical scenarios.

Conclusion

These findings suggest that periodontitis patients prefer to be well informed and share decision‐making responsibilities with healthcare professionals after their diagnosis. Factors such as age and financial burden affect their autonomy, involvement and desire for information.

Keywords: dentistry, patient autonomy, patient decisions, patient preferences, periodontitis

1. Introduction

Determining the prognosis of teeth is a critical aspect of the care of periodontitis patients, because this directly influences treatment planning (Kwok and Caton 2007). Medical/dental decision making is complex, rather than being a simple binary choice. In particular, managing periodontal disease often involves difficult decisions such as whether to pursue periodontal treatments to maintain a tooth or to opt for tooth extractions to facilitate prosthodontic or implant treatment. In many cases, different clinicians would make different prognoses for the same patient, as the assessments involve choosing from various available options, with the choices often being somewhat subjective (Lee et al. 2016). Achieving a consensus in treatment planning requires various clinical parameters to be considered, such as the level of periodontal attachment/bone loss, tooth mobility, furcation involvement and probing depths, alongside patient‐based factors such as their preferences and socio‐economic conditions (Nunn et al. 2012). These complexities make it essential to explore different approaches for integrating patient and clinical factors into the decision‐making process.

Clinical decision making is made by mutual agreement between the clinician and the patient, with various models proposed to define the roles of each party. In the ‘paternalistic’ approach, the view of clinicians as being experts results in them suggesting the preferred option for the patient (Murgic et al. 2015). However, this approach often overlooks the patient's preference for autonomy (Sandman and Munthe 2010). On the other hand, the ‘consumeristic’ approach reinforces the patient's rights by placing full authority and responsibility for treatment decisions on the patient, with minimal input from a clinician (Shutzberg 2021). This approach can also be problematic because of its neglecting the clinician's expertise, potentially compromising the quality of the decision made in the patient's best interests. To address these challenges, the collaborative model—also known as ‘shared decision making’ (SDM)—promotes equal authority and shared power between the patient and clinician, treating the patient as an active partner in the decision‐making process (Shutzberg 2021). This approach aims to promote the involvement of both parties, ensuring that decisions are made collectively for achieving the best possible health outcomes (Kriksciuniene and Sakalauskas 2022).

Clinicians often believe that patients are already well involved in their treatment decisions, whereas patients may perceive their involvement differently (Driever et al. 2020; Reissmann et al. 2019). To reduce this perception gap, research has focused on identifying factors related to patients' preferences for autonomy. Patients' desires for involvement or information‐seeking tend to vary according to certain characteristics, such as demographic factors and the nature of the disease or treatment (Chewning et al. 2012). The type of dental procedures also plays a significant role in shaping these preferences, such as the invasiveness of the treatment (Thoma et al. 2023) and its long‐term health implications (Reissmann et al. 2019). While preferences for involvement may vary, patients have consistently expressed a desire for information regardless of the disease type, stage or demographic‐related features (Burns et al. 2021; Tariman et al. 2014). Although patient‐centred care does not necessarily mean fulfilling all of their expectations, simply understanding their preferences for autonomy and their desire for information can improve patient satisfaction (Nwachokor et al. 2024).

While considerable research exists in the medical field (Chewning et al. 2012; Nease and Brooks 1995), studies on patients' autonomy preferences in dentistry remain limited. Given the complexities of periodontal decision making—where multiple treatment options exist and clinical judgements can be subjective—research in this area is particularly crucial. Therefore, the aim of this study was to characterise the autonomy preferences in decision making and information‐seeking related to dental treatment among patients diagnosed with periodontal disease, and to identify the factors influencing these preferences.

2. Materials and Methods

2.1. Study Design and Participants

A questionnaire‐based study was carried out between May 2021 and February 2022 at Yonsei University Dental Hospital. After obtaining ethical approval from the Institutional Review Board of the hospital (IRB no. 2‐2021‐0018), 96 patients were recruited on a voluntary basis. All participants provided written informed consent before being enrolled in the study. The study focused on patients with periodontal disease, specifically those diagnosed with stage III/IV periodontitis, including those who had undergone periodontal treatment or tooth extraction due to this disease. The exclusion criteria included (1) failure to provide written informed consent or (2) presence of a mental illness such as schizophrenia, depression or drug/alcohol addiction. This study followed the CROSS (Checklist for Reporting of Survey Studies) guidelines (Sharma et al. 2021).

2.2. Sample Size

The purpose of this pilot study was to gather preliminary data using the Autonomy Preference Index (API) in patients diagnosed with periodontitis. Given the exploratory nature of this study and its experimental setting, the sample size was pragmatically determined to provide relevant point estimates and effect sizes for informing future sample size calculations when performing confirmatory randomised controlled trials. A total sample size of 96 was calculated based on a previous study using the API (Colombet et al. 2020; O'Neal et al. 2008; Zizzo et al. 2017).

2.3. Questionnaires

Questionnaires were distributed to patients who agreed to participate before performing clinical examinations, during which face‐to‐face data collection took place. The six‐page self‐administered questionnaire included the following components: (a) demographic information, which was based on the Adult Oral Health Standard Set (AOHSS), and (b) the API developed by Ende et al. (1989) to assess patients' desire for autonomy. The vignette‐scenario content was tailored to dental situations; a vignette is a carefully written description of a situation designed to simulate key aspects of a real‐world scenario, such as diagnosing a specific disease (e.g., periodontal disease) (Evans et al. 2015; Gould 1996). All questionnaires underwent a Korean language validation process, in addition to referencing the validated Korean version of the API (Lee and An 2021). All questionnaire‐related procedures, including explanations of the clinical and research aspects, were conducted by a single examiner (J.Y.J.). A structured communication protocol was implemented for the person‐to‐person questionnaire administration, ensuring that all participants received the same questions in a consistent manner. This approach aimed to minimise potential biases by maintaining uniformity in data collection.

2.3.1. Demographic Information

The demographic questionnaire included the following components: socio‐demographic data (age, sex, education level, financial burden associated with care, smoking habits, alcohol consumption, oral hygiene habits, sugar consumption and experiences of tooth extraction), chronic medical conditions (cardiovascular disease, diabetes mellitus, respiratory disease, cancer and other diseases) and oral‐health‐related conditions (craniofacial abnormalities, oral cancer, oral infection, mucosal diseases, other oral diseases, visible plaque, dental appliances and types of treatments) (Table 1). The following additional items related to patients' individual oral health, oral function and pain were also included: general oral health status, ability to eat, food alteration, ability to speak, ability to sleep, productivity, self‐confidence, smiling, social participation, aesthetic satisfaction, oral pain, dry‐mouth experiences and sensitivity experiences (Riordain et al. 2021) (Table S2).

TABLE 1.

Demographic results.

N = 96 %
Age (years, mean ± SD) 52.4 ± 13.2
≤ 39 25 26.0
40–49 6 6.3
50–59 28 29.2
≥ 60 37 38.5
Sex
Female 64 66.7
Male 32 33.3
Education
High‐school graduate or lower 46 47.9
College graduate or higher 50 52.1
Financial burden
No 82 85.4
Yes 14 14.6
Smoking status
No 90 93.8
Yes 6 6.2
Drinking status
None 28 29.2
≤ 1 time/month 22 22.9
2–4 times/month 26 27.1
2–3 times/week 18 18.7
4 times/week 2 2.1
Toothbrushing
≤ 1 time/day 8 8.3
≥ 2 times/day 88 91.7
Use of fluoride tooth paste
No or I don't know 54 56.3
Yes 42 43.7
Frequency of consuming sugary foods
None 4 4.2
1 time/week 16 16.7
3–4 times/week 24 25.0
1 time/day 20 20.8
2–3 times/day 32 33.3
Number of chronic diseases
No 69 71.8
1 24 25.0
2 4 4.2
Experience for tooth extraction
No 63 65.6
Yes 33 34.4
Oral health conditions
No 94 97.9
Yes 2 2.1
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2.3.2. Decision‐Making and Information‐Seeking Preferences

The questionnaire included the API, which consists of two scales: (i) patient autonomy preferences in decision making, and (ii) information‐seeking preferences. Specifically, it comprised (1) a 15‐item scale for decision‐making preferences (6 general items and 9 vignettes), and (2) a 7‐item scale for information‐seeking preferences. These scales have been widely used in health settings to examine patients' autonomy preferences and other types of preferences (Chewning et al. 2012).

The first scale on decision‐making preferences assesses the involvement preferences of patients about whether major medical/dental decisions should be made by clinicians or by patients themselves. This scale consists of six general items and three modified dental vignettes (simulated clinical scenarios) focusing on periodontal considerations. Based on the pre‐existing vignettes related to respiratory diseases in the original API (Ende et al. 1989), dental vignettes were carefully modified to address periodontitis cases following the severity of disease as outlined in the original questionnaire. Five additional clinical professors specialising in periodontics reviewed these vignettes for verification (Table 2). In our study, three clinical vignettes from the original scale were adapted to explore the autonomy preferences of periodontitis patients regarding dental treatment decisions based on the severity of the disease: (1) decision making prior to diagnostic awareness of periodontal disease, (2) decision making in the presence of periodontal disease with a stable prognosis and (3) decision making in cases of severe periodontitis with teeth deemed to be ‘hopeless’.

TABLE 2.

Decision‐making and information‐seeking preference scale.

Mean a SD Mean score (SD) Adjusted total score (SD) b
Decision making preference: General items (6 items)
1. Important medical decisions should be made by your doctor, not by you 2.49 1.27 2.87 (0.47) 0.46 (0.20)
2. You should go along with your doctor's advice even if you disagree with it 3.04 1.29
3. When hospitalised, you should not be making decisions about your own care 2.63 1.42
4. You should feel free to make decisions about everyday medical problems c 3.72 1.14
5. If you were sick, as your illness became worse you would want your doctor to take greater control 2.27 1.16
6. You should decide how frequently you need a check‐up c 3.06 1.17
Decision making preference: Vignettes (9 items)
Vignette 1. ‘Suppose your gums have been swollen and there's been mobility in your teeth for the past 3 days. You are about to call a dental hospital. Who should make the following decisions?’
1. Whether you should be seen by the doctor d 3.42 1.02 2.69 (0.51) 0.42 (0.19)
2. Whether an oral x‐ray should be taken 2.34 0.94
3. Whether you should try taking treatments/medications 2.31 0.96
Vignette 2. ‘Suppose you visited a dental hospital intending to get scaling. Upon examination, you were told that you have progressive periodontitis. Who should make the following decisions?’
1. Whether you should initiate the treatments 2.64 0.94 2.53 (0.11) 0.38 (0.20)
2. Whether an oral x‐ray should be taken 2.57 0.91
3. Whether you should be treated with/without medication or diet 2.38 0.84
Vignette 3. ‘Suppose you visited a dental clinic due to swollen gums and loose teeth. You were diagnosed with severe periodontitis (gum disease) and apical periodontitis (tooth disease), both present simultaneously. The prognosis for preserving your teeth through treatment was considered hopeless. Who should make the following decisions?’
1. Whether you should initiate the treatments 2.67 0.98 2.53 (0.11) 0.38 (0.18)
2. Which treatment plans you should proceed with 2.53 0.76
3. Whether you should be treated with/without medication or diet 2.41 0.80
Information‐seeking preference (7 items)
1. As you become more sick, you should be told more and more about your illness 4.54 0.75 4.55 (0.08) 0.89 (0.12)
2. You should understand completely what is happening inside your body as a result of your illness 4.56 0.66
3. Your doctor should explain the purpose of your laboratory tests 4.72 0.51
4. You should be given information only when you ask for it e 2.90 1.43
5. It is important for you to know all the side effects of your medication 4.49 0.87
6. Information about your illness is as important to you as treatment 4.51 0.76
7. When there is more than one method to treat a problem, you should be told about each one 4.46 0.85
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Abbreviation: SD, standard deviation.

a

Higher scores indicated a stronger preference for autonomy.

b

Total preference score for autonomy scaled linearly from 0 to 1.

c

These items are reverse‐coded.

d

This question showed a statistically significant difference compared to the other questions, as revealed by the Friedman test.

e

The item was excluded from analysis due to low commonality.

The second scale on information‐seeking preferences measures the extent to which patients wish to receive information about their medical/dental issues. It assesses their preference for receiving explanations from clinicians and their interest in being informed about different treatment options. One item was excluded from this subscale because it was irrelevant to dental situations.

Responses for the decision‐making preferences scale, which included six general items, and the information‐seeking preference were collected using a 5‐point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. For the three modified dental vignettes, responses were gathered based on five decision‐making preferences scales: ‘the doctor alone’, ‘mostly doctor’, ‘the doctor and you equally’, ‘mostly you’ and ‘you alone’ (Table S1).

2.4. Statistical Analyses

The demographic characteristics including the AOHSS and the categories of decisions made were analysed descriptively, and quantified using frequencies and percentages. For linear regression analyses, categorical variables were refined into binary or ordinal variables. Response options for the decision‐making preference and the information‐seeking preference ranged from 1 (‘strongly agree’) to 5 (‘strongly disagree’), with higher scores indicating a stronger preference for autonomy. Total scores were then adjusted to a linear scale ranging from 0 (low autonomy, corresponding to a lack of desire for decision making or information‐seeking) to 1 (high autonomy, corresponding to a strong desire for decision making or information‐seeking). A general linear model was employed to estimate the contribution of each potential demographic variable to the two autonomy preference scales (i.e., decision‐making and information‐seeking preferences). Variables that were significant at the 10% level in the univariate model were included in the multivariate analyses.

The consistency of responses for the two autonomy preference scales was assessed using the Kaiser–Meyer–Olkin (KMO) test and Bartlett's test of sphericity, with cutoffs of a KMO value of 0.6 and a factor loading of 0.3. Both scales were further tested for internal consistency reliability, with a Cronbach's alpha coefficient cutoff of 0.6. Additionally, the three vignettes or clinical scenarios were compared using the Friedman test to identify significant differences. Post hoc analyses were conducted using the Wilcoxon rank test to further explore differences between items within each vignette. All analyses were performed with the STATA/BE statistical software package (version 18 for Windows), with the significance cutoff set at 0.05.

3. Results

3.1. Demographic Results

The baseline demographic information is presented in Table 1. The patients were aged 52.4 ± 13.2 years (mean ± SD) and comprised twice as many females as males (64 females, 32 males). Education levels were as follows: 46 patients (47.9%) had high‐school education or lower, while 50 patients (52.1%) were college graduates or held higher degrees, indicating that approximately half had a high‐school education or lower and the other half had a higher level of education. An influencing financial burden was reported by 14 patients (14.6%), whereas 82 patients (85.4%) reported no financial burden. Most patients were non‐smokers (90 patients, 93.8%). Their alcohol consumption varied, with 29.2% (28 patients) of patients reporting no alcohol consumption. Regarding oral hygiene practices, 42 patients (43.7%) used a fluoride toothpaste. The frequency of consuming sugary foods varied, with the highest proportion (32 patients, 33.3%) reporting consuming them 2–3 times a day. Most patients reported no chronic diseases (69 patients, 71.8%) and no history of tooth extraction due to periodontal disease (63 patients, 65.6%). Additionally, almost all patients reported a good oral health status (94 patients, 97.9%).

3.2. Validity and Reliability

Validity results for the item of decision‐making preferences indicated that most items had commonalities exceeding 0.6, suggesting an acceptable level of consistency. The overall validity and reliability assessments for decision‐making preference yielded a KMO value of 0.707 and Cronbach's alpha coefficient of 0.703.

Among the seven items for the information‐seeking preferences, item 4 (‘information should only be provided upon request’) displayed a significantly low commonality of 0.008, which resulted in it being excluded from the analysis. After excluding this item, the recalculated KMO value was 0.699, and the reliability estimate improved to a Cronbach's alpha coefficient of 0.749.

3.3. Decision‐Making and Information‐Seeking Preferences

Table 2 presents the scores on the API subscales for decision‐making and information‐seeking preferences. The decision‐making preference score was 2.87 ± 0.47 and had a central distribution pattern, with most responses clustered near the centre and fewer at both extremes (‘you alone’ and ‘doctor only’). The score was highest (indicating the greatest autonomy) for item 4 (‘you should feel free to make decisions about everyday medical problems’), at 3.72 ± 1.14, and lowest (indicating the lowest autonomy) for item 5 (‘if you were sick, as your illness became worse you would want your doctors to take greater control’), at 2.27 ± 1.16.

The score for information‐seeking preferences was 4.55 ± 0.08. These preferences exhibited a rightward distribution, with most responses concentrated at the higher end of the scale (indicating a strong desire for information). The highest score of 4.72 ± 0.51 was recorded for item 3 (‘your doctor should explain the purpose of your laboratory tests’).

Patient responses for both decision‐making and information‐seeking preferences were measured on an adjusted scale ranging from 0 (indicating low autonomy preference) to 1 (indicating high autonomy preference and greater desire for information). The adjusted scores for decision‐making and information‐seeking preferences were 0.46 ± 0.20 and 0.89 ± 0.12, respectively.

3.4. Patient Characteristics Affect Their Decision‐Making and Information‐Seeking Preferences

Table 3 presents the associations of decision‐making and information‐seeking preferences with socio‐demographic variables. Determinants of patient decision‐making and information‐seeking preferences that were significant at the 10% level included age, frequency of consuming sugary foods, number of chronic diseases and financial burden. The other variables that were significant included sex, education level, smoking status, alcohol consumption, frequency of toothbrushing, use of fluoride toothpaste, experiences of tooth extraction, oral health status and the AOHSS.

TABLE 3.

Univariate and multivariate regression of decision‐making and information‐seeking preference score with socio‐demographic variables.

Univariate analysis Multivariate analysis
Decision‐making preference score Information‐seeking preference score Decision‐making preference score a Information‐seeking preference score b
Coef 95% CI p Coef 95% CI p Coef 95% CI p Coef 95% CI p
Linear variables
Age −0.005 −0.007 to −0.002 0.001 c 0.001 −0.003 to 0.003 0.069 c −0.004 −0.007 to −0.001 0.008 d 0.001 −0.000 to 0.003 0.110
Toothbrushing −0.031 −0.177 to 0.114 0.671 0.053 −0.371 to 0.143 0.245
Frequency of consuming sugary foods −0.006 −0.399 to 0.026 0.688 0.007 −0.012 to 0.028 0.450
Number of chronic disease −0.088 −0.159 to −0.017 0.015 c 0.012 −0.032 to 0.058 0.582 −0.048 −0.123 to 0.026 0.199
Categorical variables
Gender
Female Ref
Male −0.058 −0.143 to 0.026 0.178 −0.028 −0.081 to 0.024 0.287
Education
High‐school graduate or lower Ref
College graduate or higher 0.056 −0.023 to 0.137 0.162 −0.024 −0.072 to 0.028 0.387
Financial burden
No Ref
Yes 0.053 −0.060 to 0.416 0.351 −0.066 −0.136 to 0.003 0.062 c −0.073 −0.141 to −0.005 0.034 d
Smoking status
No Ref
Yes 0.052 −0.114 to 0.219 0.534 −0.034 −0.138 to 0.068 0.508
Drinking status
None Ref
≤ 1 time/month −0.008 −0.121 to 0.104 0.880 −0.030 −0.098 to 0.038 0.381 −0.025 −0.092 to 0.041 0.454
2–4 times/month 0.035 −0.072 to 0.143 0.513 −0.039 −0.104 to 0.026 0.236 −0.020 −0.086 to 0.046 0.546
2–3 times/week 0.075 −0.044 to 0.194 0.214 −0.057 −0.130 to −0.014 0.115 −0.038 −0.114 to 0.036 0.309
4 time/week −0.138 −0.428 to 0.151 0.344 −0.230 −0.406 to −0.055 0.011 c −0.242 −0.413 to −0.071 0.006 d
Use of fluoride tooth paste
No or I don't know Ref
Yes −0.039 −0.120 to 0.042 0.341 −0.028 −0.080 to 0.024 0.292
Experience for tooth extraction
No Ref
Yes −0.031 −0.116 to 0.053 0.423 −0.036 −0.084 to 0.011 0.130
Oral health conditions
No Ref
Yes 0.227 −0.052 to 0.506 0.110 −0.079 −0.254 to 0.096 0.372
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Abbreviation: Ref, reference.

a

Adjusting for age, frequency of consuming sugary foods, number of chronic diseases, and financial burden.

b

Adjusting for age, frequency of consuming sugary foods, financial burden, drinking status.

c

The mean difference is significant at the 0.10 level.

d

The mean difference is significant at the 0.05 level.

Univariate analyses indicated that lower age (p = 0.001) and fewer chronic diseases (p = 0.015) were negatively associated with a preference for decision making. The trends for information‐seeking preferences differed, with these increasing with age (p = 0.069) and financial burden (p = 0.062), and decreasing with a higher frequency of alcohol consumption.

In multivariate analyses, higher age (p = 0.008), financial burden (p = 0.034) and frequency of alcohol consumption (≥ 4 times per week) (p = 0.006) were associated with a decreased decision‐making preference (p = 0.008). In other words, being older, having a higher financial burden and consuming alcohol were more frequently associated with a lower interest in decision making and a decreased desire for information.

3.5. Decision‐Making Preferences in Assessments of Periodontitis‐Simulation Vignettes

To evaluate how the severity of periodontal disease affected the preferences of patients to be involved in dental treatment decisions, scores were compared across the vignettes. The score for Vignette 1, which involved decision making before the diagnostic awareness of periodontal disease, was 2.69 ± 0.94, making it the highest among the three vignettes. The score was 2.53 ± 0.11 for both Vignette 2 (in which periodontal disease had a stable prognosis) and Vignette 3 (corresponding the advanced stages of periodontitis with teeth deemed to be unsalvageable).

Patients indicated a greater preference for involvement in decision making in Vignette 1 (decision making prior to diagnosis: ‘Suppose your gums have been swollen and there has been mobility in your teeth for the past 3 days. You are about to call a dental hospital. Who should make the following decisions?’) than in the other two vignettes focused on decision making after diagnosis. The first question in Vignette 1 had a score of 3.42 ± 1.02, which was significantly higher than the scores for all of the other questions. However, the overall scores did not differ significantly across the three vignettes.

4. Discussion

This study aimed to assess patients' decision‐making preferences regarding dental treatment and their information‐seeking behaviours, specifically focusing on patients diagnosed with periodontal disease. The main findings of this study are as follows: (1) most periodontal patients showed a strong preference for a collaborative decision‐making model; (2) nearly all of the participants expressed a strong desire to be informed, regardless of their level of autonomy; (3) a lower age was associated with a greater preference for autonomy, while the financial burden was linked to a reduced preference for information‐seeking; and (4) patients' autonomy preferences remained relatively consistent regardless of the periodontal condition, even in scenarios where some teeth were diagnosed as being unsalvageable.

Most of the periodontal patients in the current study preferred a collaborative decision‐making model, which is consistent with findings from various medical fields (Clayman et al. 2016; Say et al. 2006; Tlach et al. 2015). A systematic review has revealed that the proportion of patients preferring collaborative or autonomous decision making has gradually increased over time, from under 50% between 1974 and 1999 to over 70% in studies published after 2000, highlighting a growing desire for patients to be involved (Chewning et al. 2012). Autonomy in decision making is influenced by medical/dental issues, particularly for periodontal patients who have multiple teeth, each with its own treatment plan and prognosis. This complexity should be addressed by considering the variety of treatment options alongside the various specific types of evidence produced by experts. This might explain why periodontitis patients are more likely to want to share the decision‐making responsibilities.

Regarding information‐seeking preferences, most of the participants in the current study expressed a strong desire to be well informed. This is consistent with findings across various medical settings with diverse diseases and treatments (Connelly et al. 2019; Gaston and Mitchell 2005). Unlike autonomy preferences, the less life‐threatening nature of dental decisions did not diminish the desire of patients to be informed. Even when preferring a passive role, the patients still sought comprehensive information. Providing complete information empowers patients to make informed decisions and enhances their involvement in their decision‐making process (Entwistle et al. 2008). This focus on adequate information may help explain the gap between preferences and actual experiences, as patients often express higher expectations for involvement than they receive (Brom et al. 2014). Ensuring that patients receive adequate information is key to reducing this gap, decreasing decisional conflict, improving treatment compliance and also creating more realistic expectations (Hölzel et al. 2013).

Understanding the factors influencing autonomy and information‐seeking can help provide personalised approaches, because preferences differ among patients. In the analyses on AOHSS dataset, lower age was associated with a desire for greater autonomy, which is consistent with the findings of other medical fields (Cullati et al. 2011; Welford et al. 2012). Many studies have found that older patients tend to prefer a more traditional clinician‐led approach to health care (Lindsay et al. 2020; Schneider et al. 2006); but it is particularly interesting that some studies have found the opposite. A systematic review of mental health found that older patients had a greater desire for involvement (Burns et al. 2021) although the extent of their involvement varied across the evidence. The authors concluded that it was challenging to determine preferences for involvement with complete confidence, particularly due to the limited number and quality of studies (Burns et al. 2021). This may be due to the higher prevalence of mental health conditions among older adults, driving them to seek more control over their healthcare decisions (Ekdahl et al. 2011). The results of the self‐reported AOHSS indicated good oral health status in the present study, but it did not demonstrate a significant relationship with the desire for involvement. Although periodontitis is similarly highly prevalent among older adults, it also affects younger individuals, which explains their stronger autonomy preferences (Trindade et al. 2023).

Financial burden influenced the patients' involvement and information‐seeking in the current study, with the individuals facing financial difficulties being less likely to seek necessary dental care, which would adversely affect both their oral as well as overall health. Financial hardship creates barriers to accessing information about available dental services and options (Locker 2000; Molarius et al. 2014). Restrictions to financial resources can lead to worse health outcomes due to a lack of information and fewer options. It is essential to implement strategies that encourage patient involvement in dentistry, regardless of financial circumstances, and provide suitable tools such as evidence‐based decision aids for all age groups.

A trend observed in the current dental‐related clinical vignettes was that patients expressed a stronger preference for autonomy during the initial dental visits than after the diagnosis, regardless of their symptoms. While oral diseases can be painful, the symptoms are often bearable, which can delay the first dental visit. This can, in turn, result in missed signs of periodontal disease, worsening their condition due to inadequate oral hygiene. The delays have broader health implications, such as worsening glycaemic control in diabetes mellitus (Petersen and Ogawa 2012). Regular check‐ups can be encouraged by providing a supportive environment that motivates patients to prioritise their oral health, which might increase the early detection and management of dental diseases. A possible explanation for the decrease in autonomy after a diagnosis is the decision‐making responsibility being perceived as having shifted to the clinician. Dental professionals can promote patient engagement through SDM approaches that foster collaboration between patient and clinician.

This research explored the relatively understudied area of dentistry regarding autonomy preferences among periodontitis patients, but several limitations should be considered. First, this study was conducted at a dental university hospital with a relatively small number of patients, which could affect the generalisability of the findings. However, the associations identified between preferences and demographic factors are consistent with previous findings. Second, this study focused on autonomy preferences in the decision‐making process, without addressing subsequent actions or behaviours. Future research should explore SDM approaches in clinical practice for better fulfilling patients' preferences. Third, potential biases inherent in questionnaire‐based studies should be carefully considered, including midpoint bias, which may arise from uncertainty, social desirability or a tendency to select neutral responses to avoid extreme positions. To validate the present findings, further studies should employ diverse evaluation methods for assessing patient preferences. Fourth, much of the data were obtained using self‐report measures, which have a risk of response bias. Future studies could incorporate objective measures, such as behavioural observations or physiological assessments, alongside self‐reported data.

5. Conclusion

Periodontitis patients appear to prefer to be well informed and share the decision‐making responsibilities equally with healthcare professionals after receiving a diagnosis. The patient's age and financial burden may be potential factors influencing their preferences for autonomy and information‐seeking.

Author Contributions

Ji‐Young Jung and Kyung‐A Ko contributed to trial design, data acquisition, statistical analysis, interpretation of data and writing the draft. Franz J. Strauss and Jae‐Hong Lee contributed to reviewing and editing the draft. Jun‐Hewk Kim contributed to conducting the trial and reviewing and editing the draft manuscript. Jung‐Seok Lee contributed to conceptualization, methodology, conducting the trial, interpretation of data and critical revision of the draft manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1. Results of decision‐making and information‐seeking preference.

Table S2. Adult Oral Health Standard Set (AOHSS).

JCPE-52-960-s001.docx (26.2KB, docx)

Funding: This research was supported by a grant of the Korea Health Technology R&D Project through the Patient‐Doctor Shared Decision‐Making Research Center (PDSDM), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: RS‐2023‐KH142251).

Ji‐Young Jung and Kyung‐A Ko equally contributed to this work.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Table S1. Results of decision‐making and information‐seeking preference.

Table S2. Adult Oral Health Standard Set (AOHSS).

JCPE-52-960-s001.docx (26.2KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Articles from Journal of Clinical Periodontology are provided here courtesy of Wiley

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