Patient-centered evaluation of orthodontic care: a longitudinal cohort study of children's and parents' attitudes.

As health services are adapted to meet consumers' needs, patient-centered evaluation of quality of care as well as informed consent to treatment decisions become increasingly important concepts in orthodontics. In an attempt to assess the orthodontic service in a region, this study focused on attitudes among children and their parents. The attitudes were recorded both before and after the period in which orthodontic treatment is usually carried out. Changes in children's and parents' attitudes were applied to measure outcome of care, and to evaluate the relevance of informed consent in decisions about treatment. Seventy-nine family units were interviewed with the use of questionnaires when the child was 11 years of age and again at 16 years. Both orthodontically treated and untreated subjects were included. Responses to questions about satisfaction with dental appearance and desire for treatment were transformed to a score for orthodontic concern. A significant decrease in the concern score was observed over the 5-year period among the treated subjects, and the care system apparently identified and provided treatment to the majority of those children concerned at 11 years. Intra-unit disagreement in concern was observed among 25% of the child/parent units at the 11-year stage, whereas at 16 years nearly all units agreed. Informed consent as a tool to ensure patients' autonomy when decisions about treatment are made did not appear to be negatively affected by conflicting attitudes between children and their parents.