Shared decision-making in orthodontic education: A survey of Canadian residents' knowledge, attitudes, and practices

Shared decision-making (SDM) aligns with patient-centered care and is known to improve treatment adherence and patient satisfaction. Despite these benefits, SDM remains understudied in orthodontics. This cross-sectional study assessed SDM knowledge, attitudes, practices, and barriers among Canadian orthodontic residents, while evaluating training needs and the influence of demographic factors on knowledge and attitudes.

A web-based survey was distributed to orthodontic residents (classes 2024-2027) across all six Canadian graduate programs using voluntary sampling. Knowledge, attitudes, and barriers were measured using Likert scales, while clinical scenarios assessed practice preferences (paternalistic, informed consent, or SDM). Differences in mean scores across statements were assessed using repeated measures ANOVAs. A MANCOVA evaluated the association between demographic factors and residents' knowledge and attitudes.

Out of 88 eligible orthodontic residents, 51 completed the survey (58%). Residents reported good knowledge and expressed positive attitudes. Practices varied by scenario: while residents preferred SDM when patients were proactive (76.5%), they opted for an informed consent approach when presenting equivalent treatment options (68.6%). Barriers to SDM implementation included time constraints and patient-specific factors, such as treatment misconceptions. Most participants (78%) desired more SDM training within their graduate program. Demographic factors were not associated with residents' knowledge or attitudes.

Within the limitations of this study, Canadian orthodontic residents hold positive attitudes towards SDM, yet barriers and knowledge-practice gaps were noted regardless of Canadian demographic background. A high interest in further education, underscores a need for graduate programs to implement SDM training to bridge this gap.