Reducing anxiety in new dental patients by means of leaflets

Influence of Patient Attitude on Bracket Failure Rate: A Prospective Study

Objective:

The aim of this study is to assess the influence of general attitude and attitude toward orthodontic treatment on bracket failure rate.

Methods and Materials:

The sample comprised 128 orthodontic patients of both genders (82 women and 46 men), divided into two groups—adolescents (12-18 years old) and adults (19-25 years old), who underwent fixed orthodontic treatment with metallic braces. Two questionnaires were handed out—one before beginning the treatment and, the second, 6 months after the start of treatment. Both the questionnaires consisted of 12 questions with 5 options each, in which the attitude was scored from 1 to 5.

Conclusion:

Patients with poor attitude scoring had higher bracket failure rate and vice versa.

Randomized blinded trial of standardized written patient information before total knee arthroplasty

Background

The effect of patient education before total knee arthroplasty (TKA) is controversial. No consensus exists about the optimal content of educational interventions. In a previous study, we developed and validated an educational booklet on the peri-TKA management of knee osteoarthritis.

Purposes

Our primary purpose was to evaluate the impact of the educational booklet on knowledge among patients awaiting TKA.

Patients and methods

This randomized controlled single-blind trial evaluated standard information by the surgeon with or without delivery of the educational booklet 4–6 weeks before primary noncomplex TKA in patients aged 55–75 years with incapacitating knee osteoarthritis. Patients were enrolled at a French surgical center between June 2011 and January 2012. A patient knowledge score was determined at baseline, on the day before TKA, and 3–6 weeks after TKA, using a self-administered questionnaire developed for our previous study. The assessor was blinded to group assignment.

Results

Of 44 eligible patients, 42 were randomized, 22 to the intervention and 20 to the control group, all of whom were included in the analysis. The groups were comparable at baseline. The intervention was associated with significantly better patient knowledge scores.

Conclusions

An educational booklet improves knowledge among patients awaiting TKA. A study assessing the impact of the booklet combined with a exercise program would be helpful.

Level of evidence

Level I, randomized controlled double-blind trial; see S1 CONSORT Checklist.

Trial registration

clinicaltrials.gov #NCT01747759

A quality assessment of orthodontic patient information leaflets

BACKGROUND

Patient information leaflets (PILs) are often used to reinforce and provide further information relating to treatment choices, risks, and alternatives. An assessment of the quality of commonly used orthodontic patient information leaflets is lacking.

METHODS

A cross-sectional assessment of patient information leaflets from two international orthodontic societies was undertaken. The quality of each leaflet was assessed using the DISCERN instrument. The readability of each leaflet was assessed using the Flesch Reading Ease instrument, Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook (SMOG) index. Descriptive statistics followed by univariate analysis was conducted.

RESULTS

Thirty-six patient information leaflets were identified. Reporting of DISCERN instrument items relating to aims, description of sources, details of additional sources, consequences of no treatment, possible treatment options, and support for a shared decision process was of low quality. The overall quality score for the total sample was 44. The median Flesch Reading Ease, Flesch-Kincaid Grade Level, and SMOG index scores were 70 (interquartile range (IQR) 53.3-73.9), 7.2 (IQR 6-9.7), and 7.3 (IQR 6.7-9.1), respectively. There was a significant difference between the quality (-8.00, 95% CI: -14.62, -1.38, p < 0.001), Flesch Reading Ease (-22.30, 95% CI: -26.77, 17.83, p < 0.001) and the Flesch-Kincaid Grade Level (3.80, 95% CI: 2.74, 4.86, p < 0.001) scores between the two societies' PILs.

CONCLUSIONS

In relation to the DISCERN instrument, the quality of orthodontic PILs is deemed of moderate quality. There is a significant difference between the quality scores and the readability of PILs from different societies.

Influence of supplemental written information on adolescent anxiety, motivation and compliance in early orthodontic treatment

OBJECTIVES

To test the null hypotheses that supplementation of verbal information with written information when obtaining consent to orthodontic treatment has no effect on (1) anxiety, motivation and apprehension related to treatment and (2) compliance in the early stages of fixed appliance therapy.

MATERIALS AND METHODS

Seventy-six adolescents who were due to start fixed appliance therapy were randomly allocated to receive verbal information only or verbal and written information before orthodontic treatment. Participants' anxiety, motivation, and apprehension were assessed using a questionnaire that was completed prior to meeting the orthodontic clinician (T1), following consent to treatment (T2), and after 12 weeks of treatment (T3). Appointment attendance, appliance breakages, and periodontal scores were used as measures of patient compliance.

RESULTS

Sixty participants completed the study. At T2 there was no change in anxiety scores for either group (P = .412); however, increased motivation was detected in the group that had been given both written and verbal information (P = .049). At T3 both groups demonstrated similar reductions in anxiety (P = .311) and apprehension (P = .790) and similar levels of motivation (P = .756). A reduction in periodontal scores (P = .065), better appointment attendance (P = .732), and fewer breakages (P = .525) were reported in the group that was given additional information, although these changes were not statistically significant.

CONCLUSIONS

Supplementation of verbal information with written information resulted in improved motivation for orthodontic treatment but had no statistically significant effect on anxiety, apprehension, or patient compliance.

Consent to orthodontic treatment – is it working?

OBJECTIVE

To determine the level of patient and/or parent recall of previous consent to orthodontic treatment.

DESIGN

Patients and/or parents of children who had been consented for orthodontic treatment were asked to complete a questionnaire on consent at least six months into their treatment.

SETTING

Bristol Dental Hospital.

SUBJECTS AND METHODS

Forty-one consecutive patients and eight of their parents, with a combined age range of 12-59 years, with 61% being female and 39% male. The patients, and where applicable their parents, were identified as having previously signed a consent form at least six months previously. Each was asked to complete a questionnaire on aspects of the consent process.

RESULTS

Patients and parents demonstrated a high level of recall for the consent process concerning appliance type (89.8%), the reasons for treatment (96%), risks (75.5%), length of treatment (83.3%), the opportunity to ask questions (96%), and whether other information was provided (94%). However, further questioning on risks demonstrated poor recall for important factors such as decay (36.8%), root resorption (less than 21%), retention (56.3%) and length of retention (35%).

CONCLUSIONS

Overall the consent process works well but specific areas of concern centre around the risks of orthodontic treatment.

Otitis media with effusion: what parents want to know

Introduction:

Otitis media with effusion is a common condition of childhood. The development of an information leaflet for parents of children with the condition, and its impact on clinical management, have not previously been examined.

Patients and methods:

Eighteen doctors and 38 parents assessed the content of an information leaflet on otitis media with effusion, by applying two rounds of the modified Delphi technique. A qualitative assessment of content items was also performed.

Results:

From the 23-item list used in the first assessment round, four items had a low doctor–parent agreement and seven were excluded. Differences were also noticed in comments on the value of such leaflets, with parents being more positive about the value of leaflet distribution.

Conclusion:

During the consultation, doctors may not tell parents what they want to know, especially regarding daily care of their child. An information leaflet, developed using the Delphi technique, can help reduce this discrepancy and increase parents' satisfaction.

Knowledge of oral cancer, distress and screening intentions: longer term effects of a patient information leaflet

Study aim was to determine the influence of a patient information leaflet (PIL) on mouth cancer to improve knowledge, reduce distress and increase intention to accept a mouth screen over a 2-month period. The design was a randomised controlled trial. Two dental practices in the northwest of England participated. Standardised multi-item scales of the three outcome measures were employed. The PIL was given to a randomised intervention group of patients in waiting room. Single sheet questionnaire was completed by both groups of patients at baseline in waiting room (immediately following leaflet administration in intervention arm of study). Repeat questionnaire completion at 8 weeks by all patients through postal system. Mann-Whitney U-tests comparing outcome variables between patients with and without access to the leaflet at baseline and 8 weeks were performed. Multiple logistic regression was used to predict re-reading of the leaflet at home. Useable replies were received from 317 patients (60% response rate). All measures showed some benefit of immediate exposure to the leaflet at follow up. Older patients, less initial knowledge, and self-reported smoking positively predicted the re-reading of the leaflet. The introduction of a mouth cancer PIL into dental practice may help to inform patients about oral cancer, moderate distress and encourage acceptance of an oral health screen.

[Communication prostheses and behavioral alignment in hospital leaflets]

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

Beneficial effects of information leaflets before spinal steroid injection

How beneficial is the provision of information leaflets to low back pain patients before steroid injection under fluoroscopy?

OBJECTIVES

To compare the value of information leaflets with verbal information on steroid injection under fluoroscopy.

METHODS

Alternate month design. One hundred and twenty-three low back pain patients hospitalized for steroid injection under fluoroscopy were enrolled in the trial. Fifty-two patients received both written standardized information and non-standardized verbal information (intervention group), seventy one patients received only non-standardized verbal information (control group). Anxiety assessed at baseline evaluation and just before the injection; satisfaction related to the information received assessed on discharge day; knowledge about steroid injection assessed 4 hours and 1 month after the injection.

RESULTS

Patients had a high anxiety level at baseline evaluation. Written standardized information did not decrease significantly anxiety (P = 0.068) before the injection, had no effect on pain during the injection, but increased patients' knowledge about the adverse effects on the day of injection and 1 month later (P = 0.040 and P = 0.084 respectively), and improve satisfaction with information received about potential complications of the steroid injections (P = 0.018).

CONCLUSIONS

Providing an information leaflet to low back pain patents undergoing steroid injection under fluoroscopy tends to reduce state anxiety, and increases patients' knowledge and satisfaction with information about the risks of the injection.

The use of dental anxiety questionnaires: a survey of a group of UK dental practitioners

AIM

To determine the frequency of use of dental anxiety assessment questionnaires and factors associated with their use in a group of UK dental practitioners.

METHOD

A postal questionnaire to all 328 dentists whose names appear in the British Society for Behavioural Sciences in Dentistry Directory. Information collected for each practitioner included gender, year of qualification, type of practice in which anxious dental patients were treated, treatment used to manage anxious dental patients, type and frequency of use of dental anxiety assessment indices.

RESULTS

Questionnaires were returned from 275 (84%) practitioners. 269 were analyzed. Only 54 practitioners (20%) used adult dental anxiety assessment questionnaires and only 46 (17%) used child dental anxiety assessment questionnaires. Male practitioners were more likely to report questionnaire use in comparison with females (P< 0.05), when treating dentally anxious adults (26% v 14%). In addition, practitioners providing intravenous sedation were more likely to use an adult dental anxiety questionnaire (P < 0.04) than those who did not use intravenous sedation (29% v 15%). The type of treatment provided had a significant association with the use of child dental anxiety. Those providing general anaesthesia (P = 0.03) and hypnosis (P = 0.01) for dentally anxious children were more inclined to use a questionnaire.

CONCLUSION

The use of pre-treatment dental anxiety assessment questionnaires was low in this group of dentists. Male practitioners and those providing intravenous sedation, general anaesthesia or hypnosis seem more likely to use dental anxiety assessment questionnaires.

Factors affecting dental attendance following treatment for dental anxiety in primary dental care

AIM

To explore factors affecting patients' dental attendance behaviour following referral from a dental anxiety clinic to a general dental practitioner.

DESIGN

A four-year follow up of patients who completed a course of treatment for dental anxiety by conducting semi-structured interviews, face-to-face or by telephone, with confirmation of dental attendance from the dental records.

SUBJECTS

Forty-one patients who had completed a course of treatment for dental anxiety, in a specially designed community clinic. Mean time since last dental visit before treatment was 7.8 years (range 0.5-29).

RESULTS

Twenty-three patients were successfully followed up and 11 (47%) were receiving regular asymptomatic dental care. The dental anxiety scores of those who subsequently became asymptomatic attenders were significantly lower at follow-up than the patients who became symptomatic attenders (P = 0.01). Effective dentist-patient communication was a common theme of the interviews.

CONCLUSIONS

At four-year follow-up, dental anxiety was substantially lower in those who subsequently became asymptomatic attenders than those who became symptomatic attenders. A positive dentist-patient relationship had developed with the asymptomatic attenders.

Immediate knowledge increase from an oral cancer information leaflet in patients attending a primary health care facility: a randomised controlled trial

The aim was to determine the immediate influence of a validated patient information leaflet (PIL) on oral cancer and knowledge in primary care attenders. Participants were patients (n=800) attending their primary health care provider from 14 general practices (eight dental and six medical) in the north west of England. Measures were a previously validated knowledge questionnaire (36 dichotomous items), self-reported dental service attendance history and demographic variables. The results showed that patients who had read the oral cancer PIL demonstrated a significant increase in knowledge regardless of clinical setting (F[1,739]=246.24, P<0.0001). Patients showed improvements in selecting the correct signs and risk factors associated with disease. Immediate knowledge gain from a simple PIL about oral cancer was found and independent of the primary care facility, where the PIL was distributed.

The impact of dental anxiety on daily living

AIM

To explore the impact of dental anxiety on daily living.

METHOD

Twenty people attending a dental sedation clinic completed the Modified Dental Anxiety Scale, and were interviewed privately using a reflexive, in-depth technique. All interviews were audio-tape recorded and transcribed. The transcripts were analysed to identify the impact of dental anxiety upon the participants' daily lives. Twenty-five per cent of the qualitative data was reviewed by an independent researcher to ensure the reliability of the analysis.

RESULTS

The mean age of participants was 41 years (range 23 to 60). The mean MDAS score was 21.5 (range 14 to 25). Five main impacts of dental anxiety were identified: physiological; cognitive; behavioural; health; and social. Subsumed under these broad categories were: the fright response; a vast array of negative thoughts, feelings and fears; avoidance behaviour and behaviours related to eating, oral hygiene, and self-medication; and other manifestations of anxiety in the dental environment including muscular tension, crying and aggression were all identified. Dental anxiety was also found to disturb sleep and to have a profound affect socially, interfering with work and personal relationships.

CONCLUSION

The impact that dental anxiety can have on people's lives is wide-ranging and dynamic.

An evaluation of a communication skills workshop for dentists: cultural and clinical relevance of the patient-centred interview

The benefits for both doctors and patients of effective communication skills in medical care have been widely documented and are generally accepted. There has been less research on this topic with respect to dental care. However, based on available studies and the reported success of teaching communication skills at the undergraduate level in dental schools, a workshop was developed to improve the communication skills of dentists working in government clinics in Hong Kong. The patient-centred interview as used in medical care formed the basis for teaching communication skills in this workshop. Objective and subjective measures of dentists' knowledge, attitude and skills related to the patient-centred interview were obtained before, immediately and eight weeks after the workshops. Objective measures showed immediate gains in knowledge. However, attitudes declined during the period of study. Subjective evaluations revealed improved communication skills eight weeks after the workshop and that the patient-centred interview was considered relevant to the practices of these dentists. Participants made specific reference to the concept of empathy as a means of promoting more effective communication between dentists and patients.