Bridging the difficult talk: dentists’ perception of a patient-centred communication aid to improve oral cancer early detection

BACKGROUND: Oral cancer survival remains poor in Scotland, which is partly due to the delay of early detection. Patients' poor awareness contributes to such delays. Dentists often avoid raising the topic of oral cancer during routine check-ups, fearing patient anxiety. Question Prompt Lists (QPLs) may help by shifting the initiative to patients. This study explored dentists' perceived acceptability of using a QPL to facilitate oral cancer discussions in primary dental care. METHODS: A pre-study patient focus group informed the design. Semi-structured interviews were conducted with 21 primary care dentists working in NHS Scotland. Purposive sampling was used to ensure variation in experience. Interview data were analysed using framework analysis informed by the Theoretical Framework of Acceptability (TFA). RESULTS: Dentists welcomed the QPL as a valuable, patient-centred tool that could fulfil their ethical duty to inform patients about oral cancer screening. However, significant concerns emerged around time constraints and staffing shortages within high-pressured NHS environments, making any additional intervention feel burdensome. For successful implementation, dentists suggested two prerequisites: (1) design optimisation using short, categorised design with simple language, and (2) systemic integration which was proposed to embed QPLs into booking systems with clear clinical guidelines and systematic training. CONCLUSION: While dentists supported QPLs as an acceptable and ethical aid for opening difficult conversations about oral cancer, its successful implementation is contingent upon a user-friendly design of the tool and a systemic integration by addressing the fundamental structural inhibitors of NHS dentistry. Future interventions should focus on integrating QPLs into routine workflows rather than treating them as an add-on task.