Communication skills: dental anxiety and breaking bad news Flashcards
What are the 2 types of communication skills dentists need to communicate?
Content - What dentists communicate
Process - How dentists communicate
What is meant by the patient-centred approach?
Dentist tries to enter the patient’s world to see the illness, symptoms, condition through the patients eyes
What are the 5 main steps to the CCF?
- initiating the session
- Gathering info
- Physical examination
- Explanation and planning
- Closing the session
What is dental anxiety?
General state of apprehension prepared for something nefative to happen - anticipated dread
What is dental phobia?
Severe anxiety which results in avoidance or endurance of situation with significant discomfort - out of proportion to the actual event and level of avoidance
What % of people have moderate and extreme dental anxiety?
36% moderate
12% extreme
45% named fear of the dentist as the barrier to dental care
If have extreme anxiety what is the patient behaviour?
Frequently cancels or shows up late
Resists treatment
High stress for the patient and your team
If have moderate anxiety what is the patient behaviour?
Not pro-active in dental health, requires more time
talks through procedures
resists recommended treatment plans
Low referrals
If have low anxiety what is the patient behaviour?
Easier to treat more compliant open to treatment plans Tongue battles, gagging and tense jaw Fair referral source
What is the cycle of dental problems?
Dental fear
Delayed visiting
Dental problems
Symptom driven treatment
What is the impact of dental anxiety on the patient?
No dental care
Delayed treatment
More restorative treatment
What is the impact of dental anxiety on the dental team
Missed appointments
Higher levels of stress
Administrative and financial problems; lowered satisfaction and health and well-being
How can dental fear and anxiety affect the dentist?
Contribute to occupational stress for the clinician by absorbing patients anxiety
Being dissatisfied about the quality of treatment they are able to provide
What are the causes of dental anxiety?
Learning
Uncertaincy - fear of the unknown; lack of control, inadequate information
Personality
How is learning a cause of anxiety?
Traumatic/negative experiences (classical conditioning)
Friends/family/media (observational/vicarious)
How can personalities cause anxiety?
Patient: Neuroticism; generalised anxiety
Dentist: Negative attitudes, impersonal, uncaring, disinterested,
What is meant by classical conditioning? How can this cause dental anxiety?
Learning by association - stimulus and response
e.g. the dentist is associated with pain,the response is fear
Social learning theory Bandura 1986
Behaviour is learned from the environment through observational learning
Children learn through the observing and modelling the behaviour of others and repeat the behaviour
What are the influences of pain (pain involves an active interpretation of sensation)
Expectations; age, gender
Socio-cultural factors
Personality; emotional state
What are the implications for treatment if dentally anxious?
- communication
- behaviour management
- LA - reduces pain and anxiety
- inhalation sedation
- IV sedation
- GA
What are the 3 A’s of anxiety?
Ask - how anxious
Acknowledge - What have you heard
Address - the fears by offering solutions
What are the main Calgary-Cambridge skills needed?
Establish a supportive environment and initial rapport
Demonstrate respect and interest
Listen attentively and use silence effectively
Actively encourages patient through use of supportive words, comments, nonverbal behaviour
Use open, exploratory questions
Actively determines and explores patient’s perspective: ideas concerns, expectations
Adjust language as appropriate
Explore treatment options and negotiate a musually acceptable plan
What is cognitive behavioural theory all about?
A talking therapy/psychological treatment
Focuses on present
Helps identify the problems and find positive management strategies
Thoughts, feelings and physical sensations and actions are interconnected
What cognitive-behavioural management techniques can we do?
Reduce uncetainty - provide information prior to and during treatment
Enhance control - stop signals
Distract
What are the key features for guides for children, parents and clinicians?
Challenge unhelpful thoughts - normalises dental anxiety, provides information
Enhance control - message to dentist, stop signal contract
Reflect and plan reward
Summary of how to deal with dentally anxious patients:
Start with minor things first
Provide an initial explanation of planned procedures
Provide an explanation of procedures as they are performed
Warn that discomfort may be experienced
Give patient some control over procedures
Provide a way of distracting patient
Help the patient redefine the experience away from pain
Help the patient to cope - breathing exercises
What are the 3 steps for giving bad news?
Preparation -> discussing the news -> reviewing the situation
What needs to be done in preparation for giving bad news?
The information to be given
The setting of the interaction
Time considerations
What is the process of giving bad news?
Give the information
Check the patients understanding
Identify the patients main concerns
Elicit the patients personal resources and decide on way forward
What does the Calgary-Cambridge tell you about skills for giving bad news?
- Find out what they know
- Find out what they want to know - active listening and understanding of their prespective
- Give information - minimum jargon, introduce info incrementally, pay close attention to patient responses
- Shared decision making
What is active listening?
Encouragement: non-verbal and verbal encouragers
Silence
Repetition: echoing last few words
Paraphrasing: restating in own words, check understanding
Sharing own thoughts
What is empathy
the experience of understanding another persons condition from their perspective, place yourself in their position
How can you show empathy?
acknowledge they are emotional - ask and address
Identify the emotion, cause , show connection has been made
How do you go about shared decision making?
- shares own thinking as appropriate
- Involves the patient
- Explore patient management options
- Ascertains level of involvement patient wishes
- Negotiates a manually acceptable plan
- Checks with patient - if accepts plan and concerns have been addressed
