A qualitative study of orthognathic patients' perceptions of referral to a mental health professional: part 1--questionnaire development.

OBJECTIVES: The aim of this study was to develop a measure to assess orthognathic patients' perceptions of referral to a mental health professional. DESIGN: Prospective qualitative study. SETTING: UCLH Foundation Trust. SUBJECTS AND METHODS: The study was divided into two parts. The first phase involved developing a patient-centred questionnaire by carrying out semi-structured interviews with 10 orthognathic patients and 10 clinicians involved in orthognathic treatment provision. The transcripts from these interviews were then analysed using the N6 software package for qualitative research and thematic content analysis was carried out. As key themes and theories of patients' perceptions of referral to a mental health professional began to emerge from the data, this directed the source of further interviews, allowing exploration and validation of all theories. When new themes ceased to arise, it was assumed that data saturation was reached, and no further interviews were undertaken. A questionnaire was then developed using the key themes from the interviews and this was piloted. RESULTS: Analysis of the interviews revealed that patient views could be divided into two main themes: service provision and perceptions of mental health professionals. These themes were incorporated into a questionnaire. CONCLUSIONS: A new measure of patients' perceptions of referral to a mental health professional is presented.

A qualitative study of orthognathic patients' perceptions of referral to a mental health professional: Part 2--a questionnaire study.

OBJECTIVES: There is evidence to suggest that clinicians are reluctant to refer orthognathic patients for psychological evaluation due to fear of the patient reacting badly to the suggestion. The aim of this study was to assess orthognathic patients' perceptions of referral to a psychiatrist/psychologist using a previously developed patient-centred questionnaire. METHODS: The study was divided into two parts. Stage 1 (presented previously) involved developing the questionnaire using qualitative methodology and stage 2 involved distribution of the questionnaire to 63 orthognathic patients. This paper describes the findings of stage 2. SETTING: UCLH Foundation Trust. RESULTS: The majority of patients viewed referral to a psychiatrist/psychologist positively (95.2%), the main benefits being having someone neutral to talk to who could explain and prepare them for treatment. Patients said they would prefer the referral to be made by the clinician they are most familiar with and to see the psychiatrist/psychologist on a one-to-one basis (79.4%) in an environment they are familiar with. The main perceived drawback of seeing a psychiatrist was the inconvenience of an additional visit. CONCLUSIONS: Fear of the patient reacting badly to being referred to a mental health professional appears to be unfounded in this study of patients from a large teaching hospital and should not prevent clinicians referring patients whom they think would benefit from this.