Advance care planning
The importance of acknowledgement of emotions in routine patient psychological assessment: The example of the dental setting

https://doi.org/10.1016/j.pec.2017.05.005Get rights and content

Abstract

Objective

To investigate, by means of a conceptual model, the effect of dental staff engaging with their patients who share their level of dental anxiety in a short screening questionnaire. Methods: Three consecutive studies based in the UK primary dental care services were conducted. Each study adopted a randomised group design to focus on the possible influence on patient state anxiety of the dentist becoming aware of their patients’ dental anxiety from the self-reports of the Modified Dental Anxiety Scale (MDAS).

Results

A consistent finding in the first two studies was that the presentation of MDAS score sheet to the dentist was effective in reducing patient state anxiety when leaving the surgery. The third study provided supportive evidence that a more permanent anxiolytic effect of the presentation of the MDAS to the dentist was associated with the dentist responding openly to their patient about the fears expressed.

Conclusion

The active engagement of dental staff in the formal presentation of dental anxiety screening confers a reliable benefit to dentally anxious patients.

Clinical implications

Anxiety assessments in clinical service may give patients significant relief when staff acknowledge and engage patients when presented with their self-reported ratings.

Section snippets

Background

Communication within dentistry has always been considered essential [1], [2]. The majority of dental schools internationally require students to be trained and assessed in their interaction with their patients. The intention is to provide patients with dental treatment and care with comparative ease. This extends, to the provision of health education, advice on oral hygiene, diet and use of fluoride [3]. An area that is very demanding, as it requires frequent use of extensive communication

Aim

The overall aim of this brief paper is to show that through a careful design of discrete interventions the researcher can investigate some of the multiple factors that construct the smooth performance in the communication process of the dental staff with their patients. The structure of the paper is to present summaries of three studies conducted by the authors, two of which are already published [15], [16]. The final study is reported in an unpublished doctoral thesis [17]. They comprise a

Methods and results

Study 1 tested the hypothesis that informing dentists about patients' dental anxiety prior to commencement of treatment reduces patients’ state anxiety [15]. A randomised controlled trial was conducted. Eight General Dental Practitioners in North Wales participated. Patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on the MDAS on any one item were recruited. Patients were instructed to complete the Spielberger state anxiety

Discussion

The series of three studies provides a programme of research evidence that indicates the importance of the dentist focussing on the patient’s expressions of anxiety as recorded on paper in a routine screening assessment. Study 1 provided the first evidence that providing the dentist physically with the screening assessment of dental anxiety (MDAS) prior to the provision of dental treatment (including some form of invasive intervention i.e. prophylaxis, local anaesthetic injection, filling or

Clinical implications

This series of 3 inter-related studies, within a dental clinical setting, has demonstrated the importance of assessing procedural anxiety immediately prior to treatment intervention. A fascinating feature highlighted by this programme of research has been the importance of the clinician in engaging with the patient to discuss the specific features of the patient experience. We therefore propose the introduction of this screening device in routine practice, as it may benefit the psychological

Acknowledgements

This paper is on memory of Dr Jenny Hally (deceased) who conducted Study 3 as part fulfilment of her PhD (supervised by Profs R Freeman and G Humphris). This work was funded by the Chief Scientist Office, Scotland under their Clinical Academic Fellowship Scheme (grant number: CAF/07/02). We expressly thank the family of Dr Hally for permission to publish part of her work.

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