{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:45:03Z","timestamp":1792669503557,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":51,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Special Care in Dentistry"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Delivering dental care to individuals who lack decision\u2010making capacity involves complex ethical, legal, and clinical considerations. In England and Wales, Independent Mental Capacity Advocates (IMCAs) are required to support decisions about \u2018serious medical treatment\u2019, 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\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore dentists\u2019 experiences of appointing and working with advocates in dental care decision\u2010making and to understand the reasons for advocacy involvement and its perceived value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi\u2010structured one\u2010to\u2010one 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\u2010recorded, transcribed verbatim, and initially coded independently by four researchers. Through iterative discussion, codes were refined and organized into themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five themes were generated. Dentists demonstrated a strong commitment to optimizing patient capacity and delivering person\u2010centered care. However, there was substantial variation regarding the interpretation of \u2018serious medical treatment\u2019 in the dental context. Decisions to involve IMCAs were often based on treatment modality rather than individual patient impact. Dentists reported that advocates\u2019 involvement rarely altered proposed treatment plans and felt this was frequently associated with delays, which were perceived as counterproductive to patient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Uncertainty surrounding the definition of \u2018serious medical treatment\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clearer guidance and earlier, more meaningful advocate involvement are needed to support consistent, timely, and genuinely person\u2010centered dental decision\u2010making for patients without friends or family to support them.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scd.70276","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:28:27Z","timestamp":1792668507000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Involving Independent Mental Capacity Advocates (IMCAs) in Dental Care Decision\u2010Making: A Qualitative Exploration of Dentists\u2019 Experiences in England and Wales"],"prefix":"10.1111","volume":"46","author":[{"given":"Naomi","family":"Murray","sequence":"first","affiliation":[{"name":"University Dental Hospital of Manchester Manchester University NHS Foundation Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeena","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Special Care Dentistry Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Special Care Dentistry Oxford Health NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan A.","family":"Parsons","sequence":"additional","affiliation":[{"name":"St. Mary's University School of Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Geddis\u2010Regan","sequence":"additional","affiliation":[{"name":"University Dental Hospital of Manchester Manchester University NHS Foundation Trust Manchester UK"},{"name":"Division of Dentistry University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"NHS England.Clinical Standard: Special Care Dentistry.NHS England;2022."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.12968\/denu.2017.44.7.660"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010016\u20101934\u20109"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2380084417714789"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jphd.12077"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/scd.12631"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/23800844231199385"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ger.12687"},{"issue":"4","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/1073110519898040","article-title":"Healthcare Decision Making, and Disability Law","volume":"47","author":"Wright M. S.","year":"2019","journal-title":"Journal of Law, Medicine and Ethics"},{"key":"e_1_2_13_11_1","unstructured":"The Stationery Office.Mental Capacity Act 2005[Internet].2005.http:\/\/www.legislation.gov.uk\/ukpga\/2005\/9\/pdfs\/ukpga_20050009_en.pdf."},{"key":"e_1_2_13_12_1","unstructured":"Department for Constitutional Affairs.Mental Capacity Act 2005 Code of Practice[Internet].London: The Stationery Office;2007.https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/921428\/Mental\u2010capacity\u2010act\u2010code\u2010of\u2010practice.pdf."},{"key":"e_1_2_13_13_1","unstructured":"The Stationery Office.The Mental Capacity Act 2005 (Independent Mental Capacity Advocates) (General) Regulations 2006[Internet].2006[cited 2026 May 2].https:\/\/www.legislation.gov.uk\/uksi\/2006\/1832\/contents\/made."},{"key":"e_1_2_13_14_1","unstructured":"Scottish Government \u201cAdults With Incapacity (Scotland) Act 2000[Internet] \u201d (2000) http:\/\/www.legislation.gov.uk\/asp\/2000\/4\/contents."},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2015.08.029"},{"issue":"4","key":"e_1_2_13_16_1","first-page":"923","article-title":"Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients Without Healthcare Surrogates","volume":"33","author":"Pope T. M.","year":"2017","journal-title":"Georgia State University Law Review"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12953"},{"key":"e_1_2_13_18_1","first-page":"27","volume-title":"Qualitative Research Practice","author":"Ritchie J.","year":"2014"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12890"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41404\u2010021\u20100675\u2010x"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1258\/jhsrp.2007.007084"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215519852987"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.930080702"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2014.10.017"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsw\/bcr003"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10728\u2010018\u20100358\u2010x"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/09649060701666598"},{"key":"e_1_2_13_31_1","unstructured":"The Stationery Office. House of Lords Select Committee on the Mental Capacity Act 2005.Mental Capacity Act 2005: post\u2010Legislative scrutiny.2014."},{"key":"e_1_2_13_32_1","unstructured":"Supreme Court of the United Kingdom.Aintree University Hospitals NHS Foundation Trust v James[Internet].2013[cited 2021 Apr 11].https:\/\/www.supremecourt.uk\/cases\/docs\/uksc\u20102013\u20100134\u2010judgment.pdf."},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12880"},{"key":"e_1_2_13_34_1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1177\/2380084421998613","article-title":"Navigating the Dual Role of Clinician\u2010Researcher in Qualitative Dental Research","volume":"7","author":"Geddis\u2010Regan A. 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