Patient-centred care in general dental practice--a systematic review of the literature

Evaluation of Facial Appearance in Patients with Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review

Objective

To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images.

Design

Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol.

Result

Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP.

Conclusions

It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.

Medico-Legal Considerations in Providing Emergency Dental Care in Practice

The unpredictability of unscheduled emergency dental care carries its own clinical, communication and management challenges with associated medico-legal risks. Providing emergency dental treatment for unfamiliar patients in an unfamiliar environment amplifies the hidden pitfalls which failure to avoid can create potentially damaging critical incidents in a practitioner's professional life. These are preferably avoided through consistent attention to best practice and risk management. Day to day processes, such as excellent record-keeping, valid consent and effective communication are under the spotlight in the event that a patient complains, raises a concern with a regulator or seeks compensation following alleged negligent care. This paper aims to highlight the dento-legal pitfalls that may be pertinent in such a challenging situation.

Impact of Prominent Themes in Clinician-Patient Conversations on Caregiver's Perceived Quality of Communication with Paediatric Dental Visits

Patients’ perceived satisfaction is a key performance index of the quality health care service. Good communication has been found to increase patient’s perceived satisfaction. The purpose of this study was to examine the impact of the prominent themes arising from clinician-patient conversations on the caregiver’s perceived quality of communication during paediatric dental visits. 162 video recordings of clinical dental consultations for 62 cases attending the Paediatric Dentistry Clinic of The Prince Philip Dental Hospital in Hong Kong were captured and transcribed. The patients’ demographic information and the caregiver’s perceived quality of communication with the clinicians were recorded using the 16-item Dental Patient Feedback on Consultation skills questionnaires. Visual text analytics (Leximancer^™) indicated five prominent themes ‘disease / treatment’, ‘treatment procedure related instructions’, ‘preparation for examination’, ‘positive reinforcement / reassurance’, and ‘family / social history’ from the clinician-patient conversation of the recorded videos, with 60.2% of the total variance in concept words in this study explained through principal components analysis. Significant variation in perceived quality of communication was noted in five variables regarding the prominent theme ‘Positive reinforcement / reassurance’: ‘number of related words’ (p = 0.002), ‘number of related utterances’ (p = 0.001), ‘percentage of the related words in total number of words’ (p = 0.005), ‘percentage of the related utterances in total number of utterances’ (p = 0.035) and ‘percentage of time spent in total time duration’ (p = 0.023). Clinicians were perceived to be more patient-centered and empathetic if a larger proportion of their conversation showed positive reinforcement and reassurance via using related key words. Care-giver’s involvement, such as clinicians’ mention of the parent, was also seen as critical to perceptions of quality clinical experience. The study reveals the potential of the application of visual text analytics software in clinical consultations with implications for professional development regarding clinicians’ communication skills for improving patients’ clinical experiences and treatment satisfaction.

A Patient- and Family-Centered Care Approach to Orthodontics: Assessment of Feedbacks from Orthodontic Patients and Their Families

Objective

This study aimed to evaluate orthodontic patients and their families' clinical satisfaction and their perception of dentists in the framework of the Patient and Family Centered Care (PFCC) concept.

Methods

The study population comprised patients treated at the Orthodontics clinic and their families. A mixed method research with quantitative and qualitative components was employed by conducting questionnaires with 62 patients and 65 parents. Collected data were recorded on the computer, and analyses were performed.

Results

A majority of the patients who received treatment at our clinic were high school graduates, while their parents were university graduates. The patient's and their parents' overall satisfaction were similar. We also found that the patients and their parents expected doctors to have ethical perception and professional behavior in the treatment process.

Conclusion

According to the results obtained from the survey questionnaires, the patients and their parents expect a dentist to have the following qualities: courtesy, friendliness, respect, punctuality, communication skills, and knowledgeableness. Dentists can optimize clinical and patient satisfaction by providing care and attention based on the principles of patient centered care (PCC) and PFCC and shaped in accordance with the expectations of the patients and their parents.

Advancing Health Promotion in Dentistry: Articulating an Integrative Approach to Coaching Oral Health Behavior Change in the Dental Setting

Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients' oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients' knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned.

Can patients detect hazardous dental practice? A patient complaint study

Purpose

– The purpose of this paper is to: determine the prevalence and distribution of patient/family-generated, dentistry-related complaints to Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland from 2000 to 2011, study patient/family safety incident experiences and other reasons for complaints, assess complaint validity and evaluate factors associated with disciplinary processes against dentists.

Design/methodology/approach

– Data included closed cases handled by AVIs and Valvira (2000-2011) against dental practitioners or dental practice units (n=782). The authors analysed the complaints distribution and examined the antecedent factors and circumstances.

Findings

– This study demonstrated that patients/families can detect many dental treatment hazards, substandard processes and even serious safety risks rather well. The investigation processes revealed some physical harm or potential patient safety (PS) risks in more than half the alleged cases. Many complaints accumulated against certain individuals and statistically significant positive correlations were found between some patient/family complaints, dentist-specific variables and disciplinary actions.

Practical implications

– Patient/family-generated complaints must be taken seriously and seen as relatively good safety risk indicators. However, more knowledge on how patients might cooperate with dental care providers to prevent errors is needed.

Originality/value

– This work provides a unique opportunity to learn from several dentistry-related patient complaints. Despite some limitations, patient complaints appear to be useful as a complementary source together with other PS study methods.