Darina Nirmalann

Principal supervisor

Professor Clare Delany

Associate supervisor

Professor Rodrigo Marino, Associate Professor Rebecca Wong

Project title

Exploration of Patient-Communication in General Dental Practice in Melbourne

Abstract / overview of project

Introduction/objectives: Models of health communication, including Shared Decision Making (SDM) and Patient Centred Care (PCC), rarely focus on the specific dental context. Two goals of this research are, first to gain insight into the communication interaction between dentists and their patients and second, to ascertain whether established models of communication resonate with and are fit for purpose for this area of healthcare. Research involving interviews with dentists about communication practices and observation of dental interactions is helpful in getting a better understanding about the factors influencing how dentists communicate with their patients.

Methods: Ethnographic methods of observation were used to document routine communication occurring in dental practice and in-depth semi-structured interviews were conducted with participating dentists. Participants were 27 dentists working across a variety of public and private dental clinics in metropolitan and rural regions of Victoria (Australia). A total of 110 dental appointments were observed and audio recorded. The data was analysed using thematic analysis.

Results: An overarching finding was that, within the brief period of time allowed for communication within the dental encounter, dentists tended to set the agenda and lead the discussions.  Several sources of tension within dental/patient communication were also apparent. Dentists commonly stated their communication aimed to address patients’ expectations and yet, achieving this within a typical dental encounter was challenging. Although patients expect their dental problem to be visible, obvious, and easily fixed, in reality, the dental problem was often hidden, bigger than patients were aware of and therefore harder to fix in the one treatment session. A second source of tension was patient fear and dental anxiety. Interview data showed that dentists were aware of patient anxiety and aimed to address it. However, observation of practice highlighted that patient’s feelings were rarely explicitly raised. A third source was the nature of the dental environment and the barriers it created to dental patient communication physically and psychologically.

Discussion/implications: The research highlights unique features about dentist-patient communication and challenges dentists face in their efforts to ensure their communication is patient centred and provides opportunities for patients to share in decisions.  The findings suggest that standard models of communication such as SDM and PCC require specification for the dental context and education for dentists about clinical communication should acknowledge and address these types of everyday dentist-specific communication challenges.