Examining the feasibility of conducting a trial to evaluate interventions to encourage Dentists to provide Alcohol Advice

Background

The study forms part of Mr. Simon Shepherd’s PhD research and is supported by NES and the Scottish Dental Practice Based Research Network.  Professor Jan Clarkson and Professor Graham Ogden are co-supervisors and also co-applicants for the 12-month feasibility study that has received funding from NHS Forth Valley supported by Mr. Derek Richards, Consultant in Dental Public Health and Honorary Senior Lecturer, DHSRU.

Alcohol is a significant global public health problem and is the 3rd largest risk factor for premature mortality, disability and loss of health. There is a strong correlation between alcohol and oral cancer. The incidence of oral cancer is increasing, particularly in Scotland where the rate exceeds those in England, Wales and Northern Ireland, with risk factors such as alcohol consumption and tobacco use heavily implicated. Despite improved outcomes for many other cancers the five-year survival rate for oral cancer remains poor. As such targeting any potential preventive measures, including raising awareness of alcohol as a risk factor, is essential.

One key strategy to tackle alcohol misuse is to encourage all healthcare professionals to take an active role in identifying excessive consumption and to then provide advice on moderation.  Alcohol screening and brief intervention has emerged as a cost-effective preventative approach, which is relevant and practicable for delivery in primary healthcare.  Indeed the evidence for brief interventional advice in healthcare settings is now such that research recommendations are aimed at encouraging implementation rather than determining effectiveness. 

Dentists have a legitimate role to play in delivering such advice.  However, an elicitation study has identified barriers to dentists’ involvement in the delivery of alcohol related advice to their patients in Scotland.  Unless those specific barriers that prevent dentists from engaging with this topic are addressed it is unlikely that professional behaviour will change and the potential benefits of dentists addressing alcohol misuse will be lost.

The aim of this study is to explore the feasibility of implementing theoretically informed alcohol advice interventions in dental primary care. The objectives relate to assessing both patient and dentist acceptability of the interventions and to test and refine study processes for translation to a larger study. Translation to the main trial would aim to test the effectiveness of interventions designed to encourage dentists to deliver alcohol advice to their patients.

Aim and Objectives

The aim of this study is to explore the feasibility of implementing an alcohol advice intervention in dental primary care.

The primary objectives are:

  1. For dentists: to assess the acceptability of the interventions (time, attitudes, barriers/facilitators, difficulty/ease, advantages/disadvantages)
  2. For patients: to assess the acceptability of the interventions (attitudes, embarrassment, intrusiveness, ease/difficulty)
  3. For the stakeholders: to assess the acceptability of the intervention (financial and resource costs, methods and processes of data collection)

The secondary objectives are to:

  1. Further inform a sample size calculation
  2. Explore possible effects and associations related to the intervention approaches which may be worth following up in a subsequent larger study

Setting Population and Target Recruitment

The study is a 1-year multi-centre, parallel group, three-arm randomised controlled pilot study. A total of 15 dentists (5 in each group) working in NHS General Dental Services in NHS Forth Valley, NHS Fife and NHS Tayside who provide dental care to adult patients aged 18 and above. Dentists will screen the alcohol habits of 100 consecutive patients and provide advice according to one of three protocols. Patients will be asked to evaluate the service they receive through questionnaire and feedback forms. Participating dentists will undergo structured interview process in order to establish their acceptability of delivering advice.

Dissemination

Planned dissemination of the results includes publication in peer review journals – including high impact, open-access, and specialist journals and presentations at national and international academic and conferences.  A brief summary of the research will be developed in the style of a newsletter and made accessible to all participants.  

Research Team

Mr Simon Shepherd, Clinical Lecturer
Professor Jan Clarkson, Co-Director DHSRU
Professor Graham R Ogden, Professor of Oral Surgery, Honorary Consultant in Oral Surgery
Dr Debbie Bonetti, Senior Research Fellow
Dr Linda Young, Research Manager (NES), Member DHSRU
Mr Derek Richards,  Honorary Senior Lecturer, Consultand in Dental Public Health; Director, Centre for Evidence-based Dentistry, DHSRU
Ms. Gillian Forbes, Research Fellow 

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Collaborators