{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:51:02Z","timestamp":1791525062943,"version":"4.3.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore what factors are considered by multidisciplinary team (MDT) professionals working in cleft lip and palate services when supporting young people in their decision-making for orthognathic surgery (OS) and how professionals understand and manage ethical dilemmas that arise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative design was employed in which semistructured interviews were conducted remotely with NHS staff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nine participants were interviewed across four NHS cleft services in the United Kingdom.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The sample consisted of three Speech and Language Therapists, three Orthodontists, and three Surgeons involved in decision-making for OS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Reflexive Thematic Analysis revealed three key themes and seven sub-themes:\u201cnavigating the decision-making process,\u201d \u201cTeam-Centric,\u201d and \u2018Health Inequalities impacting on access to cleft services. Within these themes, professionals reflected on positions of power, the MDT environment, valued contribution of different professionals, external influences impacting on shared decision-making (SDM) and barriers to accessing care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings highlight the complex nature of balancing patient autonomy and beneficence during the decision-making process for OS while bringing awareness to factors that may pose a barrier to decision-making such as the presence of health inequalities, power dynamics and conditions of the MDT environment. The importance of optimizing the SDM environment and creating opportunities for liaison, particularly earlier in the pathway, are discussed. It is recommended that future research explores the impact of health inequalities on access to cleft care further, recognizing those that are currently disadvantaged in their treatment journey.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261439955","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T14:07:42Z","timestamp":1776694062000},"page":"3900-3910","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Decision-Making at the Transition Period: Widening the Lens Around Psychosocial and Cultural Factors in Cleft Orthognathic Surgery"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0393-1423","authenticated-orcid":false,"given":"Holly","family":"Clegg","sequence":"first","affiliation":[{"name":"University of East Anglia Norwich Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0491-6564","authenticated-orcid":false,"given":"Kiki","family":"Mastroyannopoulou","sequence":"additional","affiliation":[{"name":"University of East Anglia Norwich Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliane","family":"Young","sequence":"additional","affiliation":[{"name":"Cambridgeshire and Peterborough NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Cleft Lip and Palate Action (CLAPA). The cleft treatment timeline. Accessed February 26 2026. https:\/\/clapa.com\/what-is-cleft-lip-palate\/how-is-cleft-treated\/cleft-treatment-timeline\/#info."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ortho\/25.1.21"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12663-019-01217-w"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/2864216"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1357109"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ortho.2019.08.016"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2024.101795"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1597\/08-093.1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221125377"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00238-019-01530-0"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.65626"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.12968\/bjhc.2021.0051"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2001.3411736.x"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1179\/146531205225021492"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619866552"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656241236006"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656241236006"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1597\/11-127"},{"key":"e_1_3_3_20_2","unstructured":"Acum M. End of pathway cleft surgery: Exploring the patient-reported outcomes and young people\u2019s decision making experiences. Doctoral Thesis. University of East Anglia Norwich UK; 2018 Accessed October 24 2025. https:\/\/ueaeprints.uea.ac.uk\/id\/eprint\/68908\/."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pecinn.2024.100362"},{"key":"e_1_3_3_22_2","volume-title":"Successful qualitative research: A practical guide for beginners","author":"Braun V","year":"2013","unstructured":"Braun V, Clarke V. Successful qualitative research: A practical guide for beginners. 1st ed. London: Sage; 2013.","edition":"1"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1080\/2159676x.2019.1628806"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","unstructured":"Braun V Clarke V. 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