Involving Independent Mental Capacity Advocates (IMCAs) in Dental Care Decision-Making: A Qualitative Exploration of Dentists' Experiences in England and Wales.
5 affiliations
- 1University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester, UK.
- 2Department of Special Care Dentistry, Barts Health NHS Trust, London, UK.
- 3Department of Special Care Dentistry, Oxford Health NHS Foundation Trust, Oxford, UK.
- 4St. Mary's University School of Medicine, London, UK.
- 5Division of Dentistry, University of Manchester, Manchester, UK.
Abstract
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.
Related
- A qualitative exploration of community health workers' roles and motivations in delivering care during and after the COVID-19 pandemic: experiences and community perceptions in rural and urban Delhi, India.
- A qualitative exploration of variations in social prescribing in primary care for people living with dementia in England: Barriers and enablers to positive service experiences
- Suicidal ideation, depressive experiences, and resilience among adolescents living with HIV in rural Ghana: a qualitative exploration of psychological experiences and coping
- Trans, non-binary and gender diverse adults' experiences of accessing sexual healthcare: a qualitative exploration
- “Even with one Man, but with many women, you can get cervical cancer”: Qualitative exploration of women’s perceptions and experiences of cervical cancer screening in Uganda: A community-based study
BibTeX
@article{murray2026involving,
title = {{Involving Independent Mental Capacity Advocates (IMCAs) in Dental Care Decision-Making: A Qualitative Exploration of Dentists' Experiences in England and Wales.}},
author = {Naomi Murray and Jeena Patel and Lucy Taylor and Jordan A Parsons and Andrew Geddis-Regan},
journal = {Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry},
year = {2026},
month = sep,
doi = {10.1111/scd.70276},
url = {https://europepmc.org/article/MED/42910656},
note = {CC BY},
}
RIS
TY - JOUR
TI - Involving Independent Mental Capacity Advocates (IMCAs) in Dental Care Decision-Making: A Qualitative Exploration of Dentists' Experiences in England and Wales.
AU - Naomi Murray
AU - Jeena Patel
AU - Lucy Taylor
AU - Jordan A Parsons
AU - Andrew Geddis-Regan
PY - 2026
DA - 2026/09/01
JO - Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry
DO - 10.1111/scd.70276
UR - https://europepmc.org/article/MED/42910656
AB - 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.
SN - 0275-1879
SN - 1754-4505
ER -