How often do dentists use patient communication techniques in the U.S.?

This summary is based on the article published in the Journal of the American Dental Association: Dentist-patient communication techniques used in the United States. The results of a national survey (May 2011)

• Gary Rozier, DDS, MPH
• Alice M. Horowitz, PhD
• Gary Podschun, BA

Context

• Communication between dental care providers and patients long has been recognized as an important part of providing dental care.^1-4
• Good dentist-patient communication has a number of potential positive outcomes, including reduced patient anxiety; increased patient satisfaction, motivation and adherence to healthy behaviors; and better oral health outcomes.
• Conversely, inadequate or negative dentist-patient communication can create barriers to care and undesirable outcomes.
• Interpersonal relationships, of which communication is a key component, seem to be as important to patients as the technical aspects of dental care, if not more so.⁵
• Contributing to the problem of low literacy skills is the growing complexity of dental disease prevention and treatment, and the increased demands that this trend places on the information needs of the public. Thus, even patients who use dental services regularly can face challenges in participating adequately in treatment decisions.
• The American Dental Association (ADA) House of Delegates approved the five-year Health Literacy in Dentistry Action Plan in 2009 that recommended the ADA “[c]onduct ongoing surveys of … dentists and dental team members … to monitor health literacy related knowledge, attitudes and behaviors.”³²

Purpose of the Survey

• To determine the techniques they use to ensure effective communication with patients and their understanding of oral health information.
• To study the variation in routine use of these techniques according to a number of factors that we thought would affect their use and that can be targeted with interventions to improve communication between dentists and patients.

Methods

• American Dental Association Survey Center staff members mailed an 86- item questionnaire to a random sample of 6,300 U.S. dentists in private practice.
• Participants reported routine use (“most of the time” or “always”) during a typical week of 18 communication techniques, of which seven are basic techniques.
• The authors used analysis of variance and ordinary least squares regression models to test the association of communication, provider and practice characteristics with the number of techniques.

Key Findings

Appropriate level of use

• Communication techniques used by dentists may not accommodate the literacy skills of some patients:
  • The number of communication techniques dentists used varied substantially, and, on average, dentists routinely used a low percentage of the techniques included in the survey.
  • Less than one fourth of dentists routinely used teach-back methods in which patients are asked to repeat information or instructions back to the practitioner to check for understanding—methods that health literacy experts recommended for universal use.^35-37
  • Patients’ evaluations of the quality of communication within dental practice suggest gaps between their literacy skills and dentists’ ability to meet their needs and expectations.^40,41

Factors influencing use of communication techniques

• Dentists younger than 36 years used the fewest communication techniques of any age group.
  • This finding might reflect the attitudes held by dentists at the time of their graduation from dental school.
  • An alternative hypothesis is that dentists graduate with good communication skills but choose not to use them when faced with other practice demands during their initial years of clinical practice.
  • However, both expert panels and empirical evidence suggest that instruction in communication skills is inadequate in many dental schools and that some dentists likely graduate without the communication skills to meet the needs of patients with low literacy rates.^9,11,46
• Specialists, with the exception of pediatric dentists, used more communication techniques than did general dentists.
• Pediatric dentists and general dentists used about the same number of communication techniques, but they used fewer than did dentists in other areas of dentistry.
• The predictor variable that had the strongest association with communication practices was outcome expectancy. Unsuccessful attempts to change patients’ behaviors can discourage dentists from making further counseling efforts.

References

List of references included in the article (PDF)