Involving Independent Mental Capacity Advocates (IMCAs) in Dental Care Decision‐Making: A Qualitative Exploration of Dentists’ Experiences in England and Wales
Naomi Murray, Jeena Patel, Lucy Taylor, Jordan A. Parsons, Andrew Geddis‐ReganABSTRACT
Introduction
Delivering dental care to individuals who lack decision‐making capacity involves complex ethical, legal, and clinical considerations. In England and Wales, Independent Mental Capacity Advocates (IMCAs) are required to support decisions about ‘serious medical treatment’, a concept given only broad definition in law. While Special Care Dentistry frequently involves patients with cognitive impairments, little is known about how dentists engage with advocates in treatment decision‐making.
Objective
To explore dentists’ experiences of appointing and working with advocates in dental care decision‐making and to understand the reasons for advocacy involvement and its perceived value.
Methods
Semi‐structured one‐to‐one online interviews were conducted with nine dentists. Data were generated and analyzed concurrently using a maximum variation sampling approach and Reflexive Thematic Analysis. Interviews were audio‐recorded, transcribed verbatim, and initially coded independently by four researchers. Through iterative discussion, codes were refined and organized into themes.
Results
Five themes were generated. Dentists demonstrated a strong commitment to optimizing patient capacity and delivering person‐centered care. However, there was substantial variation regarding the interpretation of ‘serious medical treatment’ in the dental context. Decisions to involve IMCAs were often based on treatment modality rather than individual patient impact. Dentists reported that advocates’ involvement rarely altered proposed treatment plans and felt this was frequently associated with delays, which were perceived as counterproductive to patient care.
Discussion
Uncertainty surrounding the definition of ‘serious medical treatment’ contributes to inconsistent advocate involvement and may limit the effectiveness of advocacy. A broader, individualized understanding of seriousness, incorporating clinical, functional, and personal consequences, is needed.
Conclusion
Clearer guidance and earlier, more meaningful advocate involvement are needed to support consistent, timely, and genuinely person‐centered dental decision‐making for patients without friends or family to support them.