Dentist-patient communication in primary dental care (Version 1.0)
Research type
Research Study
Full title
Dentist-patient communication and anxiety in primary dental care
IRAS ID
246499
Contact name
Suzanne Scott
Contact email
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Summary of Research
Dentists could have a key role in encouraging early presentation of cancer by talking to patients to raise awareness of oral cancer. During routine appointments, dentists check patients’ mouths (screen) for signs of oral cancer as well as dental/gum health. Yet some dentists do not currently tell patients they are doing so. A survey found 92% of dental patients wanted their Dentist to inform them that they are being screened for oral cancer yet 88% did not know if they had ever been checked. We have developed an evidence-based ‘oral cancer communication guide’, which offers clear guidance to equip Dentists to communicate effectively about oral cancer with their patients. This includes key messages for an interactive discussion about symptoms, the importance of early detection, and when to seek help for symptoms. A training programme has been developed alongside the communication guide. We run training sessions at King's College London, for dental teams and at the British Dental Association Conference / UK Dentistry Show. Trained dentists reported fewer perceived barriers to communicating about oral cancer and became more confident to talk about oral cancer with patients. However, it is not known how the communication guide is used or adapted in everyday practice; to whom do dentists choose to speak to about oral cancer. Furthermore, even after training, some dentists still seemed concerned about raising patient anxiety by discussing oral cancer. The proposed research aims to investigate the extent to which the guide is implemented by the dental team as intended (intervention fidelity) and the response of the dental patient.
In this year-long study, participating adult patients attending two primary dental care practices for a routine check-up will complete a questionnaire before and after their consultation which will be audio-recorded to determine if and how dentists spoke about oral cancer.Summary of Results
All audio-recorded dental consultations included a discussion about oral cancer to some extent. The dentist spoke to patients about oral cancer for between 34 and 193 seconds. On average, the dentist discussed 7 different topics with each patient when talking about oral cancer out of possible 10.
The dentist varied in the extent to which they encouraged the conversation to be interactive, with 84% of patients being asked what they knew prior to a discussion of signs and symptoms. Specific advice on the duration of symptoms (three-week rule) was included in 88% of consultations. Topics that were rarely discussed were ‘where to seek help for symptoms’ (1%) and ‘barriers to seeking help’ (0%).
The average level of state anxiety was lower after the appointment compared to before the appointment. There was no correlation between the number of oral cancer topics discussed and patient state anxiety after the appointment or between the number of oral cancer topics discussed and the change in state anxiety pre to post appointment.
Smoking status was the only factor associated with the number of oral cancer topics discussed. The dentist discussed more oral cancer topics with patients who smoked or used to smoke.
Patient’s initial responses to hearing about oral cancer screening were either short neutral replies (n=39, 51%) or positive comments (n=17, 22%). The remaining patients (27%) gave no audible response. No patients reacted negatively to the discussion.
Patient questions were unprompted rather than invited by the dentist. There were relatively few (n=8) patient questions in response to talking about oral cancer screening. Those that were asked related to either the novelty of screening for oral cancer, their own symptoms, or risk factors for oral cancer.In sum, the dental team was able to discuss oral cancer within the confines of a time-pressured appointment and this did not raise patients’ anxiety. The findings should reassure dental professionals and encourage endeavours to raise awareness of oral cancer within the dental practice.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
19/NE/0221
Date of REC Opinion
3 Jul 2019
REC opinion
Favourable Opinion