1. Introduction Flashcards
1
Q
Why is behavioural science important?
A
- easy to assume things are as they seem or as you think
- assumptions are untested theories - need to put them to rigorous scientific tests
- allows dentists to believe in facts rather than opinions
2
Q
How is behavioural science subjective?
A
- humans study human behaviour
- can’t separate ourselves from the study
- base expectations and beliefs on experiences we’ve had
- diversity is so important - need to be explicit about assumptions our models and approaches are based on
3
Q
Explain the behaviour iceberg theory
A
- observable behaviour is a small part of the experience
- we can see behaviours and results but not the beliefs, values, thinking and emotions that have led to it
- need to be tentative and open to questioning
4
Q
How can a dentist engage with behavioural science?
A
- ask what are my assumptions?
- what theories are there?
- what is the evidence?
- how can i test and apply my theories and evidence to a dental context?
5
Q
2 models of communication skills
A
- active listening
- motivational interviewing
6
Q
Advantages of both active listening and motivational interviewing
A
- both emphasise importance of cultivating a mutually respectful relationship
- makes it clear you are listening
- both frequently taught to staff groups in clinical care
7
Q
What did Wendy Levinson find about doctor patient interactions?
A
- doctors who have never been sued spend 18.3 mins on average with patients, orienting comments such as first, i will examine you then discuss any cocnerns etc and use active listening such as tell me more about that
- doctors who have been sued at least twice spend 15 minutes on average, have less patient-centred style but still provide same quality info and level of detail
8
Q
Procedure for Wendy Levinson’s research
A
- observers watched 4-10 second clips from doctor-patient conversations which were content-filtered and were asked to rate warmth, hostility, dominance and anxiousness
- on basis of this, could reliably predict which doctors would get sued
- most imp quality was dominance (sued group) versus concern (not sued group)
9
Q
What did Moore find out about dental anxiety?
A
- in 1993, in a Danish population of 208 ps
- 122 feared the whole process/feeling of powerlessness
- 106 feared drilling/sound
- 62 feared pain in treatment
- 45 feared needle
- subset of 80 ps were interviewed and commented that dentists should not make condescending remarks, act in dominant manner, appear too busy, not stop for pain, not talk at all, not explain things or use technical dental language
10
Q
What social impact of dentistry are people scared of? (Moore)
A
- 53/80 - 66% - of interviewed subset described being socially embarassed about dental fear problem and inability to do something about it
- most reported it had an impact on condition and appearance of teeth
11
Q
How did the dental fear come about? (Moore)
A
- 66/80 had traumatic dental experience (usually in childhood)
- in 20/80, was pain
- 24 were being held down
- 32 ‘hard-handed dentists’
- 13 couldn’t isolate a reason
12
Q
What does Armfield say causes dental fear?
A
- some people with traumatic dental experimental experiences do not end up with dental fear
- some people with dental fear did not have a traumatic experience
- in a survey of 1084 Australian adults, perceptions of dental treatment that it’s unpredictable, uncontrollable, dangerous and disgusting are more predictive of fear than previous dental experiences
13
Q
What is the vicious cycle of dental fear?
A
- dental fear and anxiety
- leads to delayed visiting
- leads to dental problems
- leads to symptom-driven treatment
- leads back to dental fear and anxiety
- evidence shows interaction between patient and dentist when they do attend treatment is important
14
Q
From Calladine, Currie and Penlington, going to the dentist worries me because …
A
- even though my teeth feel okay, i don’t know if they will tell me there is something wrong (63% agree)
- makes me worry my teeth are bad (61%)
- makes me feel vulnerable (54%)
- painful experience (39%)
15
Q
According to Clladine, Currie and Penlington, it would be helpful if the dentist …
A
- would tell me the condition of all my teeth, not just those that need treatment (86%)
- had a conversation with me at start of appointment about what will happen (82%)
- explained the meaning of the codes they’re using to assess my teeth (71%)
16
Q
Process of Calladine, Currie and Penlington
A
- survey of 154 members of British Public
- questions generated by interviews with 5 people about feelings re. dental appointments
17
Q
Main themes through Calladine, Currie and Penlington
A
- control
- shame
- discomfort
- cost
- long-term impact
18
Q
Scientist Practioner Method
A
- don’t make assumptions
- use systematic methods to test out different theories and methods of intervention
- learn from outcomes of investigations
- report investigations in detail so others can repeat same procedure
- many professions work with scientist practitioner model. highly relevant to behavioural science as human behaviours and interactions can be very subtle and obvious
- consistent with reflective practice, a key aspect of dental professionalism
19
Q
Medical Model of Care
A
- dominant philosophy of thinking about health and illness which dominates much medical care offered in Western cultures today
- diagnosis and treatment
- focus is objective disease
- signs and symptoms expected to resolve with treatment
- continuing symptoms related to unresolved pathology
20
Q
Biopsychosocial model
A
- Engel 1977
- developed from recognition that some people with physcial illness recover better than others and seems to be influenced by lots of factors
- useful when considering why people do/don’t engage in protective behaviours like regular attendance/tooth brushing
- social, biological and psychological factors
21
Q
Examples of social factors
A
- interactions between patient and dental team
- attitudes of family, friends, society
- access to transport, mobility, finance
- work and family commitments
22
Q
Examples of psychological factors
A
- thoughts (beliefs, attitudes, memories of past experiences)
- feelings
- behaviours
23
Q
The importance of acknowledgement of emotions in routine patient psychological assessments (example in dental setting) - study 1
A
- patients high in dental anxiety filled in an anxiety questionnaire before visiting dentist (STAI-S)
- also filled out the MDAS - patients randomised into 2 groups
- group 1, their dentists were given their MDAS copy
- group 2, weren’t
- after app, filled out STAI-S again, patients anxiety in group 1 reduced more than group 2
24
Q
The importance of acknowledgement of emotions in routine patient psychological assessments (example in dental setting) - study 2
A
- patients with high dental anxiety filled out STAI-S before dental visit
- randomised into groups
- control had no MDAS
- another group - filled out MDAS and handed to receptionist - didn’t know they gave it to the dentist
- another group filled out MDAS and handed directly to dentist
- compared to other groups, those handing straight to dentist much less anxious (on STAI-S) when leaving surgery
25
The importance of acknowledgement of emotions in routine patient psychological assessments (example in dental setting) - study 3
- high dental anxiety patients video'd and heart rate monitored during interaction with dentist
- all filled MDAS before app and into 2 groups
- handed MDAS to dentist or handed MDAS to receptionist
- STAI-S repeated after appointment and 3 months later. groups did not significantly differ in anxiety by end of app
- patients whose dentist had taken time to discuss and acknowledge MDAS score had improved anxiety after app and 3 months later than others
26
Study to show Reassurance and Distress Behaviour in Preschool Children undergoing Preventative Care Procedures
- extended duty dental nurses applying fluoride varnish in nursery settings to children aged 2-5
- children given reassurance were less likley to accept application of fluoride varnish
- interactions recorded and analysed through video coding
- increased anxiety-related behaviours following reassurance, especially early in consultation
- praise, instruction, info-giving and paying a compliment were more often followed by co-operation
- led researchers to consider whether nurses were responding to their own anxiety rather than children's when provided reassurance
27
How to influence patient oral hygeine behaviour effectively
- 2 psych models of behaviour change to plan structured intervention to encourage best practice oral hygeine behaviours
- best evidence available suggests dentist should provide chair-side oral hygeine advice about method and timing of brushing, provide and reccomend use of powered toothbrush with rotation/oscillation action and instruction in use of toothbrush
28
Explain brief intervention based on 2 psych theories
- Self-efficacy theory
- self efficacy is a key factor in whether people engage in behaviour, defined as a person's confidence in ability to perform behaviour
- practising behaviour, observing others, verbal persuasion, how people feel after
- Implementation Intention theory
- likelihood of a person performing a behaviour is increased by making an explicit action plan about where and when the behaviour is performed.
- action plans function as cuees that remind a person to perform behaviour
29
Compare the standardised intervention and usual hygeine advice
- standardised gives info on EXACTLY ehat to do, for how long, and how it should feel
- demonstrate on a model of a mouth
- ask patient to clean teeth with electric toothbrush, correct if necessary and praise
- give electric toothbrush and ask when best time is to use it
- compared to usual hygeine where it's delivered as a normal conversation
30
Compare results of standardised intervention and usual hygeine advice
- intervention group improved significantly more than control group on self-efficacy, planning and self-reported toothbrushing technique
- bleeding at gumline and plaque score improved in this group too compared to control - statistically significant in only 1 of 2 studies
- suggested further studies needed to clarify
31
How stress can impact individuals in dental team?
- take more time off
- arrive to work late
- be twitchy/nervous
- mood swings
- withdrawn
- loss of motivation/confidence/commitment
- heightened sensitivity/tearfulness/aggressiveness
32
How can stress impact dental teams as a whole?
- arguments
- higher staff turnover
- more sickness absence
- decreased performance
- more complaints and grievances
33
Define 'burnout'
- emotional and physical exhaustion
- resulting from a combination of exposure to environmental and internal stressors and inadequate coping and adaptive skills
- person exhibits increasingly negative attitude towards job, low-self esteem and personal devaluation
34
In a medical setting, burnout is linked to...
- not fully discussing treatment outcomes
- not answering a patient's questions
- less favourable ratings by patients
35
Factors affecting wellbeing in dentists
- high levels of work related stress
- active coping required
- stigma
- peer networks
36
How is managing stress a professional responsibility?
- Standards for the Dental Team Standard 9.2
- you must protect patients and colleagues from risks posed by your health, conduct and performance
37
Prevalence of minor psychiatric symptoms from Myers and Myers
- dentists 32%
- doctors 27.2%
- general pop 17.8%
- BDA research paper suggests pressure of 4 challenges combined contributes to burnout
- emotional (dealing with anxious patient), cognitive (complex treatment decisions), physical (maintaining difficult posture),
quantitative (short time allocated for patients)
38
Study on resilience in dentists at Newcastle university
- interviews with dentists at Newcastle University from newly qualified to Head of School
- nearly half interviewed reported to have felt unwell at times in careers due to stress or mental health problems
- many didnt want to show as worries about stigma
- most didn't realise others sometimes felt the same
- several thought of themselves as less resilient or weak compared to others
39
How do dentists deal with difficulty?
- culture of 'professional socialisation' which stigmatizes support seeking
- not weak or unusual to experience distress
- resilience comes from courage to acknowledge a problem and flexibility to respond by doing something different
- consider balance of activities important for staying well and ways of responding to significant problems
