Bone graft preferences and cognitive dissonance in patient counselling: a cross-sectional survey of clinicians
- 1Department of Dentistry and Oral Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
- 2BDS Karachi Metropolitan University, Karachi, Pakistan
Abstract
Background: To evaluate clinicians’ preferences for bone graft materials and to investigate the presence of cognitive dissonance in their counselling practices during informed consent.
Methods: This cross-sectional survey of dental consultants in Pakistan assessed ranked preferences for five bone graft materials (autograft intraoral/extraoral, allograft, xenograft, and alloplast) and their influencing factors. Cognitive dissonance in counselling practice was quantified as the discrepancy between clinicians’ stated beliefs and reported behaviours using an adapted discrepancy index (D = B – A) across four clinical scenarios. Statistical analyses included Friedman, Kruskal-Wallis, and Wilcoxon signed-rank tests with Bonferroni correction (p < 0.0125).
Results: Autologous bone grafts were most preferred, primarily due to superior integration, whereas alloplasts were least preferred due to concerns regarding failure and future complications. Preferences were consistent across specialties and experience levels. While clinicians reported high importance for all counselling domains, significant belief-behaviour discrepancies were observed in providing written information, discussing treatment costs, and incorporating patient preferences (p < 0.001). No significant discrepancy was noted in disclosing graft sources.
Conclusions: Clinicians consistently prefer autologous bone grafts, aligning with evidence. However, they demonstrate belief-behavior discrepancies indicative of cognitive dissonance in key aspects of patient counselling, potentially undermining informed consent and patient autonomy. Structured consent protocols and targeted training are needed to align clinical behaviours with ethical intentions.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09526-6.
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BibTeX
@article{khawaja2026bone,
title = {{Bone graft preferences and cognitive dissonance in patient counselling: a cross-sectional survey of clinicians}},
author = {Ahsan Khawaja and Nighat Naved and Zara Pervaiz and Fahad Umer},
journal = {BMC Oral Health},
year = {2026},
month = aug,
doi = {10.1186/s12903-026-09526-6},
url = {https://doi.org/10.1186/s12903-026-09526-6},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Bone graft preferences and cognitive dissonance in patient counselling: a cross-sectional survey of clinicians
AU - Ahsan Khawaja
AU - Nighat Naved
AU - Zara Pervaiz
AU - Fahad Umer
PY - 2026
DA - 2026/08/07
JO - BMC Oral Health
DO - 10.1186/s12903-026-09526-6
UR - https://doi.org/10.1186/s12903-026-09526-6
AB - Background: To evaluate clinicians’ preferences for bone graft materials and to investigate the presence of cognitive dissonance in their counselling practices during informed consent. Methods: This cross-sectional survey of dental consultants in Pakistan assessed ranked preferences for five bone graft materials (autograft intraoral/extraoral, allograft, xenograft, and alloplast) and their influencing factors. Cognitive dissonance in counselling practice was quantified as the discrepancy between clinicians’ stated beliefs and reported behaviours using an adapted discrepancy index (D = B – A) across four clinical scenarios. Statistical analyses included Friedman, Kruskal-Wallis, and Wilcoxon signed-rank tests with Bonferroni correction (p < 0.0125). Results: Autologous bone grafts were most preferred, primarily due to superior integration, whereas alloplasts were least preferred due to concerns regarding failure and future complications. Preferences were consistent across specialties and experience levels. While clinicians reported high importance for all counselling domains, significant belief-behaviour discrepancies were observed in providing written information, discussing treatment costs, and incorporating patient preferences (p < 0.001). No significant discrepancy was noted in disclosing graft sources. Conclusions: Clinicians consistently prefer autologous bone grafts, aligning with evidence. However, they demonstrate belief-behavior discrepancies indicative of cognitive dissonance in key aspects of patient counselling, potentially undermining informed consent and patient autonomy. Structured consent protocols and targeted training are needed to align clinical behaviours with ethical intentions. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09526-6.
SN - 1472-6831
ER -