Purpose
The purpose of this protocol is to set out the aims, objectives and commitments of the Oral and Dental Health Priority Setting Partnership (PSP) and the basic roles and responsibilities of the partners therein.
Steering Group
The Steering Group will lead and manage the PSP. The steering group includes representation of patients, carers and clinicians. It will agree the resources, including time and expertise that they will be able to contribute to each stage of the process. The JLA will advise on this.
The Oral and Dental Health PSP Steering Group will comprise:
Patient and Public Representatives
- Smile Aiders - Richard Boards
- Health Watch - Diana Charles
- Born in Bradford - Rosie McEachan
Clinical Representatives
- British Association for Disability and Oral Health - Blanaid Daly
- Scottish Dental Clinical Effectiveness Programme - Jan Clarkson
- Dental Schools Council - Chris Deery
- Faculty of General Dental Practice (FDGP) - Onkar Dhanoya
- Public Health England - Jenny Godson
- NHS England - Sara Hurley
- Faculty of General Dental Practice (FDGP) - Ian Mills
- British Society for Oral & Dental Research - Rebecca Moazzez
- British Society for Dental & Hygiene Therapy - Emma Pacey
Project Team
- Steering Group Chair and James Lind Alliance Senior Adviser, James Lind Alliance - Katherine Cowan
- Priority Setting Partnership Lead and National Specialty Lead for Oral and Dental Health, University of Bristol and National Institute for Health Research Central Research Network Coordinating Centre (NIHR CRN) - Peter Robinson
- Priority Setting Partnership Manager, National Institute for Health Research Central Research Network Coordinating Centre (NIHR CRNCC) - Shamaila Anwar
- Information Specialist, Cochrane Oral Health Group - Yin-Ling Lin
- Methodologist, Dental Translational and Clinical Research Unit School of Dentistry (University of Leeds) - Sue Pavitt
- National Institute for Health Research Central Research Network Coordinating Centre (NIHR CRNCC) - Jonathan Gower
- Cochrane Oral Health Group - Anne Marie Glenny
Declaration of interests
Steering Group members will be required to complete the JLA Declaration of Interests document to create a culture of transparency and help the JLA Adviser manage potential bias.
Background to the Oral and Dental Health PSP
The James Lind Alliance (JLA) is an initiative which is hosted by the National Institute for Health and Care Research. Its aim is to provide an infrastructure and process to help patients and clinicians work together to agree which are the most important treatment uncertainties affecting their particular interest, in order to influence the prioritisation of future research in that area. The JLA defines an uncertainty as a “known unknown” – in this case relating to the effects of treatment.
The Oral and Dental Health PSP was instigated from observations that few large scale clinical studies were being conducted in the UK (as evidenced by the size of the NIHR Oral and Dental Portfolio), that much oral and dental research in this area was fragmented and could be more ambitious, collaborative and multi-centre. There was also a perception that Oral and Dental Research was not prioritised by research funders and that funding calls could be better targeted to key areas.
Aims and objectives of the Oral and Dental Health PSP
The aim of the PSP is to identify the unanswered questions related to Oral and Dental Health from patient and clinical perspectives and then prioritise those that patients and clinicians agree are the most important.
The objectives of the PSP are:
- to work with patients, lay people and clinicians to identify uncertainties related to interventions to improve oral health and/or reduce oral health inequalities.
- to agree by consensus a prioritised list of those uncertainties, for future research
- to publicise the results of the PSP and process
- to take the results to research commissioning bodies to be considered for funding
Focus of the PSP
The interventions might include policies, health promotion, diagnosis, treatment, service delivery and psychological interventions and may or may not also improve general health.
As NIHR is an NHS organisation the priorities will relate to health promotion, prevention and NHS oral care.
Given the broad range and universal experience of oral disease, the PSP will not be structured around particular diseases but will focus on three population groups:
- Children and young people
- Adults
- People requiring special care and older people
These three groups may overlap.
Exclusion criteria
The following areas of research are excluded
- The treatment of oral cancer after diagnosis (general oral health care of people with cancer may be included in the PSP)
- Causes and mechanisms of disease
- Comparisons or biomedical evaluations of orthodontic treatment will be excluded. However, the individual and societal costs and benefits of orthodontic care may be included, as may be dental prevention and treatment of people with oro-facial clefts.
Partners
Organisations and individuals will be invited to take part in the PSP, which represent the following groups:
- people who have received oral and dental health interventions (i.e. anybody!)
- formal and informal carers of people who have been dental patients, especially those such as children or people who need special care where the carers are important in ensuring access to care
- dentists, dental care professionals (DCPs) and other health and social care workers involved in oral health interventionsIt is important that all organisations that can reach and advocate for these groups should be invited to become involved in the PSP. The JLA will take responsibility for ensuring the various stakeholder groups are able to contribute equally to the process.
Organisations wishing to participate in the PSP will be asked to affiliate to the JLA in order to demonstrate their commitment to the aims and values of the JLA. Please note the affiliation procedure formerly available on the JLA website was discontinued in 2015.
Partner groups might include:
- Charities associated with oral health or specific population groups (Age UK, CLAPA etc.)
- Population groups
- Professional organisations including NIHR, FGDP, BSODR, NHSE, Department of Health, Public Health England, Cochrane Oral Health Group
Exclusion criteria
Some organisations may be judged by the JLA or the Steering Group to have conflicts of interest. These conflicts of interest may be perceived to adversely affect the organisations’ views, causing unacceptable bias. As this is likely to undermine the PSP findings, such organisations will not be invited to participate. However, interested parties may participate in a purely observational capacity when the Steering Group considers it may be helpful.
Methods
This section describes a schedule of proposed stages through which the PSP aims to fulfil its objectives. The process is iterative and dependent on the active participation and contribution of different groups. The methods adopted in any stage with be agreed through consultation between the partners, guided by the PSP’s aims and objectives. More details and examples can be found in the JLA Guidebook.
Identification and invitation of potential partners
Potential partner organisations will be identified through peer knowledge and consultation, through the Steering Group members’ networks and through the JLA’s existing register of affiliates. Potential partners will be contacted and informed of the establishment and aims of the Oral and Dental Health PSP and invited to participate.
The Steering Group will draft the invitation specific to potential groups, and the invitation will be distributed through a variety of mechanisms including editorials in relevant journals, newsletters, emails and social media.
Initial stakeholder awareness raising (Virtual)
The initial stakeholder awareness raising will have several key objectives:
- to welcome and introduce potential members of the Oral and Dental Health PSP
- to present the proposed plan for the PSP
- to identify those potential partner organisations that will commit to the PSP and identify individuals who will be those organisations’ representatives and the PSP’s principal contacts
- to establish principles upon which an open, inclusive and transparent mechanism can be based for contributing to, reporting and recording the work and progress of the PSP
Gathering uncertainties
Each partner organisation will be asked to contact its members to solicit questions and uncertainties of practical clinical importance relating to interventions for Oral and Dental Health. A period of 3 months will be given to complete this exercise.
The principle method will involve a questionnaire that will
- Be designed to be as inclusive as possible using graphics and text (cartoon at beginning etc.)
- Contain and accessible preamble explaining the rationale for the PSP and the purpose of the questionnaire
- Comprise largely open questions
- Have electronic and paper formats allowing it to be used interactively online or to be used in hard copy as a semi-structured interview schedule with groups of people (e.g. by a partner organisation)
- Be designed by Yin Ling, Peter Robinson and the Steering Group, in collaboration with the partner organisations
The principle method may be adapted according to the nature and membership of each organisation, but must be as transparent, inclusive and representative as practicable. The questionnaire may take the form of email consultations, postal or web-based questionnaires or internet message boards or may be used at membership meetings (such as conferences), and focus groups.
Existing sources of information about treatment uncertainties for patients and clinicians will be searched. These can include question-answering services for patients and carers and for clinicians; research recommendations in systematic reviews and clinical guidelines; protocols for systematic reviews being prepared and registers of ongoing research.
The starting point for identifying sources of uncertainties and research recommendations is NHS Evidence.
Unanswered questions have been identified in previous Cochrane prioritisation exercises and the recent PHE Oral Health prioritisation. The British Orthodontic Society is also conducting a similar but more highly specified exercise.
Processing initial uncertainties
The initial uncertainties will be processed in five stages, led by Yin Ling. Katherine Cowan and the Steering Group will observe this processing, to ensure accountability and transparency.
a. Compiling the gathered data
The data will be compiled from all sources into a single master dataset of raw uncertainties in an Excel file (template provided) as described in the JLA Guidebook.
b. Removing out of scope submissions
Raw submissions that do not meet the inclusion criteria or that meet the exclusion criteria will be removed from the dataset. The removed submissions should be kept in a separate file that can be verified by members of the Steering Group
c. Categorising the eligible submissions
The data will be subject to content analysis to categorise the data into themes. This stage may be facilitated by using the framework of population groups (Children and young people, Adults and People requiring special care and older people) or by the type of intervention (policies, health promotion, diagnosis, treatment, service delivery and psychological interventions)
d. Formatting the submissions
Where necessary the remaining submissions will be rephrased to clarify the precise uncertainty. Where possible indicative questions may be compiled from groups of similar submissions using the PICO format
- Patient or population
- Intervention
- Comparator or control
- Outcome
Combining duplicates into indicative uncertainties in this way will be used to reduce data volume. The resulting indicative questions should be clear, researchable and understandable to all.
Data quality during this processing stage is essential so that no uncertainties are excluded unnecessarily. The analysis will be assured by PR and other members of the steering group by checking the master dataset against the indicative uncertainties
e. Verifying the uncertainties
Yin Ling will lead the verification that the remaining uncertainties are uncertain by checking against existing systematic reviews and evidence–based guidelines. She will be supported in this task by Anne-Marie Glenny (COH) and clinicians on the steering group who will guide the searches and assist in the interpretation of the evidence. The quality of supporting systematic reviews will be assessed using AMSTAR; guidelines will be assessed using the AGREE checklist.
Uncertainties arising from research recommendations in these sources will also be added to the list of uncertainties.
- Cochrane database of systematic reviews
- NICE guidelines
- Scottish Intercollegiate Guideline Network
- Faculty of Dental Surgery RCS guidelines
- British Society of Paediatric Dentistry
- British Society of Restorative Dentistry
- British Society of Prosthodontics
- British Society of Periodontology
- British Society for the Study of Community Dentistry
- British Society for Disability and Oral Health
- British Association of Oral Surgeons
- British Society for Gerondontology (BSG)
Uncertainties that can be resolved with existing evidence ("unrecognised knowns") imply that information is not being communicated to those who need it. The PSP will record these answerable questions, and consider how best to communicate them.
The following fields will be recorded for every uncertainty by the time the initial uncertainties are processed:
Uncertainty - The indicative uncertainty formatted using the PICO question structure.
Original uncertainty - Contains original survey submissions. Multiple submissions relating to the same indicative uncertainty will be grouped and recorded as ‘-‘
Evidence - Lists the evidence checked to verify the uncertainty, incl. ref to most recent SR +<2 other SRs
Source of uncertainty - Lists type of people who submitted uncertainty (e.g. pts x 5, clinicians x 2 etc)
Final ranking - This column is completed at the final workshop
Notes - Plain language summary <150 words explaining uncertainty and its importance (applies to final <30 priority questions only)
After final workshop datasheet to be updated to include agreed changes, including final ranking and explanatory note then sent to JLA for publication.
Interim Prioritisation
Interim prioritisation will result in the ranking of the long list of verified uncertainties. From this, the top 20-30 questions will be taken to a final priority setting workshop.
Longlisting:
If the long list of questions is deemed too long (eg more than 80 unique uncertainties), the Steering Group will need to reduce it using agreed critieria, for example (as proposed by the JLA):
- Whether the question has been raised by lay people and clinicians
- The number of times the question has been suggested
- The range of professionals who have proposed the questions
- Whether the question has been raised in other fora or in other research recommendations
Katherine Cowan will observe and guide this process to ensure fairness and transparency
Ranking:
The formal interim prioritisation will involve an electronic survey. Partner and stakeholder organisations will be invited to consult their membership to choose and rank their top 10 most important uncertainties. This stage may also involve the respondents to the first survey, if they indicated an interest in being involved, and wider promotion via the PSP’s networks and social media.
The completed data will be analysed separately for lay people and clinicians. The uncertainties will be scored with the ranks from each participating organisation reversed (ie ranked first scores 10, ranked second scores 9 etc) and the scores for the uncertainties summed for lay people and clinicians.
The sums for the lay people and clinicians will then be ranked and scored as above, then the cumulative scores (lay people + clinicians) will be ranked.to produce a shortlist of 25-30 uncertainties.
Final priority setting
The final priority setting will rank all 25-30 questions and will specifically agree the top 10 prioritised uncertainties in a face to face workshop, using Nominal Group Technique (small and large group discussions and ranking). This will be independently facilitated by the JLA. The workshop will adopt the principles and ground rules outlined in the JLA guidebook.
Participants:
The participants will comprise <30 lay people, patients, carers of patients and a range of clinicians (1º care, 2º care and public health dentists, DCPs and non-dental health and social workers involved in oral health care)
Participants will be requested to provide a short biography of themselves that can be circulated ahead of the workshop. Participants will be expected to declare their interests in advance of this meeting.
Dissemination and implementation
Dissemination
Partners and Steering Group members will publish the PSP findings using both internal and external communication mechanisms. The JLA may also capture and publicise the results, through descriptive reports of the process itself.
The steering group will disseminate the results of the PSP in X ways:
- Lay summaries suitable for non-professional organisations will be drafted in a variety of media and circulated for use in partner organisations’ websites and newsletters
- Steering Group members and partners will be encouraged to develop the prioritised uncertainties into research questions to use when approaching potential funders, or when allocating funding for research themselves, if applicable.
- This will be achieved via presentations at conferences and workshops and peer-reviewed manuscripts prepared for online journals
- ‘News’ type reports will be prepared for professional non-academic journals such as the BDJ etc
- Members of the steering group will be able to report back to the organisations they represent (NHSE, PHE, BSODR, DSC, charities etc) for further dissemination and implementation
- The priorities will be passed on to funding agencies (NIHR, which includes the HTA Programme, MRC) to highlight the areas that patients and clinicians consider to be most important for research.
Agreed by the Steering Group
The Steering Group agrees to follow Oral and Dental Health PSP Protocol.