Decision-Making at the Transition Period: Widening the Lens Around Psychosocial and Cultural Factors in Cleft Orthognathic Surgery

ObjectiveTo explore what factors are considered by multidisciplinary team (MDT) professionals working in cleft lip and palate services when supporting young people in their decision-making for orthognathic surgery (OS) and how professionals understand and manage ethical dilemmas that arise.DesignA qualitative design was employed in which semistructured interviews were conducted remotely with NHS staff.SettingNine participants were interviewed across four NHS cleft services in the United Kingdom.ParticipantsThe sample consisted of three Speech and Language Therapists, three Orthodontists, and three Surgeons involved in decision-making for OS.ResultsReflexive Thematic Analysis revealed three key themes and seven sub-themes:"navigating the decision-making process," "Team-Centric," and 'Health Inequalities impacting on access to cleft services. Within these themes, professionals reflected on positions of power, the MDT environment, valued contribution of different professionals, external influences impacting on shared decision-making (SDM) and barriers to accessing care.ConclusionsThe findings highlight the complex nature of balancing patient autonomy and beneficence during the decision-making process for OS while bringing awareness to factors that may pose a barrier to decision-making such as the presence of health inequalities, power dynamics and conditions of the MDT environment. The importance of optimizing the SDM environment and creating opportunities for liaison, particularly earlier in the pathway, are discussed. It is recommended that future research explores the impact of health inequalities on access to cleft care further, recognizing those that are currently disadvantaged in their treatment journey.