Communication skills: dental anxiety and breaking bad news

Question 1

What are the 2 types of communication skills dentists need to communicate?

Answer 1

Content - What dentists communicate

Process - How dentists communicate

Question 2

What is meant by the patient-centred approach?

Answer 2

Dentist tries to enter the patient’s world to see the illness, symptoms, condition through the patients eyes

Question 3

What are the 5 main steps to the CCF?

Answer 3

1. initiating the session
2. Gathering info
3. Physical examination
4. Explanation and planning
5. Closing the session

Question 4

What is dental anxiety?

Answer 4

General state of apprehension prepared for something nefative to happen - anticipated dread

Question 5

What is dental phobia?

Answer 5

Severe anxiety which results in avoidance or endurance of situation with significant discomfort - out of proportion to the actual event and level of avoidance

Question 6

What % of people have moderate and extreme dental anxiety?

Answer 6

36% moderate
12% extreme
45% named fear of the dentist as the barrier to dental care

Question 7

If have extreme anxiety what is the patient behaviour?

Answer 7

Frequently cancels or shows up late
Resists treatment
High stress for the patient and your team

Question 8

If have moderate anxiety what is the patient behaviour?

Answer 8

Not pro-active in dental health, requires more time
talks through procedures
resists recommended treatment plans
Low referrals

Question 9

If have low anxiety what is the patient behaviour?

Answer 9

Easier to treat 
more compliant 
open to treatment plans 
Tongue battles, gagging and tense jaw
Fair referral source

Question 10

What is the cycle of dental problems?

Answer 10

Dental fear
Delayed visiting
Dental problems
Symptom driven treatment

Question 11

What is the impact of dental anxiety on the patient?

Answer 11

No dental care
Delayed treatment
More restorative treatment

Question 12

What is the impact of dental anxiety on the dental team

Answer 12

Missed appointments
Higher levels of stress
Administrative and financial problems; lowered satisfaction and health and well-being

Question 13

How can dental fear and anxiety affect the dentist?

Answer 13

Contribute to occupational stress for the clinician by absorbing patients anxiety
Being dissatisfied about the quality of treatment they are able to provide

Question 14

What are the causes of dental anxiety?

Answer 14

Learning
Uncertaincy - fear of the unknown; lack of control, inadequate information
Personality

Question 15

How is learning a cause of anxiety?

Answer 15

Traumatic/negative experiences (classical conditioning)

Friends/family/media (observational/vicarious)

Question 16

How can personalities cause anxiety?

Answer 16

Patient: Neuroticism; generalised anxiety
Dentist: Negative attitudes, impersonal, uncaring, disinterested,

Question 17

What is meant by classical conditioning? How can this cause dental anxiety?

Answer 17

Learning by association - stimulus and response

e.g. the dentist is associated with pain,the response is fear

Question 18

Social learning theory Bandura 1986

Answer 18

Behaviour is learned from the environment through observational learning
Children learn through the observing and modelling the behaviour of others and repeat the behaviour

Question 19

What are the influences of pain (pain involves an active interpretation of sensation)

Answer 19

Expectations; age, gender
Socio-cultural factors
Personality; emotional state

Question 20

What are the implications for treatment if dentally anxious?

Answer 20

1. communication
2. behaviour management
3. LA - reduces pain and anxiety
4. inhalation sedation
5. IV sedation
6. GA

Question 21

What are the 3 A’s of anxiety?

Answer 21

Ask - how anxious
Acknowledge - What have you heard
Address - the fears by offering solutions

Question 22

What are the main Calgary-Cambridge skills needed?

Answer 22

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

Question 23

What is cognitive behavioural theory all about?

Answer 23

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

Question 24

What cognitive-behavioural management techniques can we do?

Answer 24

Reduce uncetainty - provide information prior to and during treatment
Enhance control - stop signals
Distract

Question 25

What are the key features for guides for children, parents and clinicians?

Answer 25

Challenge unhelpful thoughts - normalises dental anxiety, provides information Enhance control - message to dentist, stop signal contract Reflect and plan reward

Question 26

Summary of how to deal with dentally anxious patients:

Answer 26

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

Question 27

What are the 3 steps for giving bad news?

Answer 27

Preparation -> discussing the news -> reviewing the situation

Question 28

What needs to be done in preparation for giving bad news?

Answer 28

The information to be given The setting of the interaction Time considerations

Question 29

What is the process of giving bad news?

Answer 29

Give the information Check the patients understanding Identify the patients main concerns Elicit the patients personal resources and decide on way forward

Question 30

What does the Calgary-Cambridge tell you about skills for giving bad news?

Answer 30

1. Find out what they know 2. Find out what they want to know - active listening and understanding of their prespective 3. Give information - minimum jargon, introduce info incrementally, pay close attention to patient responses 4. Shared decision making

Question 31

What is active listening?

Answer 31

Encouragement: non-verbal and verbal encouragers Silence Repetition: echoing last few words Paraphrasing: restating in own words, check understanding Sharing own thoughts

Question 32

What is empathy

Answer 32

the experience of understanding another persons condition from their perspective, place yourself in their position

Question 33

How can you show empathy?

Answer 33

acknowledge they are emotional - ask and address | Identify the emotion, cause , show connection has been made

Question 34

How do you go about shared decision making?

Answer 34

1. shares own thinking as appropriate 2. Involves the patient 3. Explore patient management options 4. Ascertains level of involvement patient wishes 5. Negotiates a manually acceptable plan 6. Checks with patient - if accepts plan and concerns have been addressed