What are orthognathic patients' expectations of treatment outcome--a qualitative study.

PURPOSE Patient's expectations of treatment outcome are one of the key determinants of satisfaction. The aim of this study was to evaluate orthognathic patients' expectations of the outcome of orthognathic treatment. METHODS This study was a cross-sectional qualitative study involving in-depth interviews with patients with dentofacial deformities. Patients who were about to commence orthognathic treatment were recruited from new-patient clinics. Inclusion criterion were patients of any ethnicity 16 years or older who were about to commence orthognathic treatment to correct a dentofacial deformity. Exclusion criteria were patients who had previously received orthognathic treatment, who were younger than 16 years, and those with congenital craniofacial anomalies or acquired defects. The data were analyzed using a framework approach to management and critical qualitative theory, which involved identifying the main themes and subthemes. RESULTS Eighteen adult patients 18 to 40 years old were interviewed; 9 were women and 9 were men. Most were Caucasian and 6 were from the black and minority ethnic group. Participants' expectations could be divided broadly into 2 main categories: expectations of actual physical changes and expectations of the effects that these physical changes would indirectly have on them (nonphysical changes). In addition, a typology of patients, based on expectations, was identified, whereby patients could be classified as metamorphosizers, pragmatists, shedders, or evolvers, together with implications and suggestions for practice. CONCLUSIONS These findings represent a new insight into the complex issues of managing patient expectations and satisfaction. The clinical relevance of identifying expectations is not just to ration treatment or identify those who will make good or bad candidates for treatment, but to be able to offer them additional support to enhance satisfaction with the outcome. This highlights the need for a qualitative methodology to complete the full circle of evidence-based practice.