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Biomedical subjects

N L Corah

Publications and source records attributed to N L Corah.

At least 19 recordsLinked to original sources
PubMed1991

Dental students' treatment of anxious patients.

Patients' anxiousness over treatment is an important factor in the utilization, delivery, and outcome of health care. Patient anxiety over dental treatment is widespread and is a source of stress for both patients and dentists. This paper reports a study of how dental students cope with fearful patients they treat during training, and what tactics they believe are effective. Two classes of senior dental students at a state university (n = 127) completed a brief questionnaire that asked them to describe what they had done in a previous encounter with a nervous patient, and to assess the effect of their actions. Students estimated that almost a quarter of their patients were anxious; most believed that they themselves were made nervous by such patients. Virtually all were committed to using talk plus local anesthesia rather than more extensive, drug-oriented methods. The coping repertoire was extensive. Giving reassurance was the most prominent tactic, followed by providing information about the procedure; expressing empathy or identifying patient feelings and the source of fear; and presenting a calm manner. Most students believed their actions had at least some positive, if not a dramatic, effect. In rating the effectiveness of 10 actions a dentist can take to deal with patient anxiety, the large majority of students rated every behavior as being at least somewhat effective. The behaviors rated 'very effective' by half or more of the students included having a calm manner, demonstrating that what the patient says is taken seriously, being friendly, making the patient feel welcome, and giving moral support during the procedure.

Adaptation, Psychological↗
PubMed1988

The dentist-patient relationship: perceived dentist behaviors that reduce patient anxiety and increase satisfaction.

This study relates perceived dentist behaviors to anxiety reduction in patients during treatment, and to satisfaction with the dental visit. The sample consisted of 250 adult patients, 110 men and 140 women, at two outpatient hospital dental clinics. Immediately after treatment, patients were asked to respond to a list of 25 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained by patients were self-ratings of anxiety during treatment and satisfaction measures from the DVSS. Ten behaviors were significantly associated with anxiety reduction. A stepwise multiple regression analysis with anxiety reduction as the dependent variable indicated that to the patient, the dentist's explicit dedication to prevent pain was the most important dentist behavior, with friendliness, working quickly, being calm, and giving moral support, being important auxiliary behaviors. Most of the 25 dentist behaviors studied were associated with patient satisfaction. A stepwise multiple regression analysis indicated that the dentist's empathy and communicativeness were among important correlates of patient satisfaction. An experimental approach to causal analysis of anxiety reducing behaviors needs to be studied.

Adolescent↗
PubMed1988

Dental anxiety. Assessment, reduction and increasing patient satisfaction.

A conceptual schema relating a number of patient and dentist variables to patient anxiety reduction and satisfaction was presented. Evidence was examined that indicates that patient compliance with preventive and treatment regimens can be influenced in a major fashion through variables that reduce anxiety and increase satisfaction with the dentist. An accounting of several studies that investigated behavioral strategies for reducing patient stress during dental procedures indicated that recorded relaxation instructions and the active distraction provided by playing a video game can be effective anxiety-reducing treatments. Attempts to find other useful behavioral strategies were unsuccessful--only relaxation and distraction were consistently successful in reducing stress in moderately anxious patients. Observations of dentist-patient interaction in the context of the behavioral strategy studies indicated that the doctor-patient relationship was an important dimension associated with patient anxiety reduction and satisfaction. A series of investigations were conducted to elucidate the dentist behaviors that were associated with these variables. We found that the dentist behaviors most closely associated with patient satisfaction were those portraying empathy, friendliness, and a calm, competent image to the patient. The most important behavior associated with anxiety reduction was the dentist's explicit promise to prevent pain. Other dentist behaviors--friendliness, being calm, giving moral support--were seen as providing an appropriate behavioral context in support of the pledge to prevent pain. Finally, we considered the need for the dentist to be aware of patient anxiety in order to effectively deal with it. If nothing else, asking about anxiety gives the patient permission to express concerns that are present. If the patient is not anxious, asking about anxiety will not produce it. Two types of measuring instruments were considered in relation to assessing anxiety. The Dental Anxiety Scale, a brief four-item scale, was judged to be a reliable and valid method for assessing general dental anxiety. In addition, a new interval scale of anxiety response was discussed for those occasions on which it is important to assess the patient's response to treatment.

Anxiety↗
PubMed1986

Why patients change dentists: practitioners' views.

Dentists participating in a health screening at the 1984 annual session completed a brief questionnaire concerning patient turnover. In most dentists' opinions, patients more frequently leave a practice for reasons independent of the practice: they change residences and jobs. Patients' dissatisfaction with how they are treated, with the quality of care, and with pain and anxiety control also are believed to be among the factors "pushing" away patients. Lay referral is the major source of new patients, together with general community reputation and practice location.

Anxiety↗
PubMed1986

The dentist-patient relationship: mutual perceptions and behaviors.

The relationship between patients' characteristics and dentists' perceptions as well as the associations between these dimensions and specific dentist behaviors as perceived by patients are explored. Dentist perceptions of patient sophistication and anxiety were related to several patient characteristics, but perceptions of patient likability were unrelated to patient personal and social characteristics. Perceptions of patient likability were associated with more specific dentist behaviors than were other dentist perceptions noted by patients. The results suggest that dentists' views are influenced primarily by those patient characteristics manifested during treatment. In general, dentists like patients who are dentally sophisticated and not anxious.

Adolescent↗
PubMed1985

The dentist-patient relationship: perceptions by patients of dentist behavior in relation to satisfaction and anxiety.

This study relates perceived dentist behaviors to anxiety in patients during treatment and to satisfaction during the dental visit. The sample consisted of 231 adult patients, 107 men and 124 women, at a public hospital dental clinic. Immediately after treatment, patients were asked to respond to a list of 21 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained were ratings of anxiety by patients during treatment and measures from the DVSS. None of the dentist behaviors was related to anxiety in patients in a way that would suggest that dentist behavior either reduced or increased anxiety. DAS scores obtained before treatment were the best predictor of anxiety in patients during treatment. Most of the dentist behaviors were significantly related to satisfaction in patients. Stepwise multiple regression analyses using DVSS scores as criterion variables indicated that those variables contributing most to satisfaction in patients were indicative of dentist communication that was accepting and caring. Anxiety in patients during treatment also was an important negative predictor of satisfaction. The results indicate that the dentist behaviors explored in this study were associated with satisfaction in patients, but were not clearly related to anxiety reduction.

Anxiety↗
PubMed1985

Dentists' management of patients' fear and anxiety.

Dentists participating in a health screening at the 1983 ADA annual session were asked to complete a brief questionnaire concerning their attitudes and methods of managing anxious patients. Most dentists see patient fear as an extremely important dimension of their practice and believe it to be the most important impediment to patient satisfaction. Behavioral methods such as "talking" appear to be the most frequently used methods of dealing with fearful patients. Finally, most dentists appear to learn their behavioral management methods through informal means.

Anxiety↗
PubMed1984

Development of a patient measure of satisfaction with the dentist: the Dental Visit Satisfaction Scale.

Although patient satisfaction has been studied in the traditional medical context, patient satisfaction with the dentist has received only minor attention. This paper reports the development of a 10-item Dental Visit Satisfaction Scale. This scale was designed to assess patient satisfaction with the dentist in the context of a specific visit. It provides three subscales--Information-Communication, Understanding-Acceptance, and Technical Competence--as well as an overall measure of satisfaction. Satisfactory internal consistency was obtained for all scale measures, and one assessment of construct validity is reported. Potential clinical and research applications are discussed.

Adult↗
PubMed1984

Comparison of three distraction techniques in reducing stress in dental patients.

Three types of distraction were investigated in the dental operatory with patients receiving amalgam restorations. The distraction conditions included an audio-comedy program, a video-comedy program, and a video game. The results indicated that both the video comedy and the video game successfully distracted patients during the dental procedure. The data suggest that successful distraction is accompanied by an increase in physiologic arousal. This finding contrasts with earlier reports of the use of relaxation in which a decrease in physiologic arousal occurs during dental procedures. It was suggested that the choice for use of the successful distraction procedures be based on other practical considerations.

Arousal↗
PubMed1984

Sources of dentists' stress.

Almost 1,000 American dentists attending the 1982 Association annual meeting completed a self-administered questionnaire on sources of stress in dental practice. Most respondents identified dentistry as more stressful than other occupations. However, most believed that other dentists were under more stress than themselves. Dentists use a variety of ways to cope with their stress but a fourth report they do nothing. The stressors particularly noted included falling behind schedule, striving for technical perfection, causing pain or anxiety in patients, canceled or late appointments, and lack of cooperation from patients in the chair. However, all of the 25 listed stressors were endorsed by at least some dentists. Among the stressors lowest in the composite ratings included: isolation from fellow practitioners, competition, monotony, lack of acceptance by patients of the preferred treatment plan, and lack of appreciation. An exploratory factor analysis leads us to hypothesize six sources in dentists' stress: problems of patients' compliance, pain, and anxiety; interpersonal relations; the physical strain of work; economic pressures; third-party constraints; and the strain of perfectionism and seeking ideal results. As the well-being of the dentist and that of the staff and patients are dependent on successful management of occupational strains, this topic deserves more empirical study than it has so far received. We strongly suggest more studies dealing with stresses that occur daily in the immediate environment of office, waiting room, and operatory.

Dentist-Patient Relations↗
PubMed1982

Dentists' perceptions of problem behaviors in patients.

Our sample of 376 dentists in general practice provided a number of useful insights into the problems that dentists experience with their patients. For general problems of patient cooperation, the frequency of occurrence and annoyance to the dentist were related. High on the list in both categories were maintaining poor oral hygiene, missing or being late for appointments, and not paying bills. Not providing an accurate history ranked first in bother to the dentist but appears to occur infrequently. When specific chair problems were considered, an inverse relationship was found between frequency of occurrence and bother to the dentist. Showing fear was the most frequent behavior but ranked lowest in bother. Grabbing the dentist's hand ranked first in bother but last in frequency of occurrence. Some annoying patient behaviors, such as those that devalue, criticize, or question the dentist's performance, are attempts to cope with anxiety. Viewed in this fashion, the incidence of fear-related behaviors may be higher than actually perceived by dentists. Because such behaviors are likely to result in feelings of personal assault on the dentist's part, they are likely to have a deleterious effect on the dentist-patient relationship. Dentists who are able to avoid feeling threatened by patient hostility may be able to successfully resolve the potential conflict to the mutual benefit of both dentist and patient. The actual problems that dentists have with their patients have been neglected and need extensive research. Our study is a first attempt to outline the boundaries of this area. Even these descriptive findings point to crucial elements in dentist-patient relationships. We hope that our findings will lead to further research on the dentist in the dentist-patient equation as well as to practical means of coping with the problems that patients present.

Attitude of Health Personnel↗
PubMed1981

Relaxation and musical programming as means of reducing psychological stress during dental procedures.

Relaxation and musical programming as techniques designed to reduce stress during operative dental procedures were evaluated with a number of different measures. The results indicate that relaxation is an effective method of reducing patient anxiety. However, the results with musical programs suggest that music, at best, results in a placebo effect. This effect is similar to that of administering an inactive drug that produces beneficial effects in some patients some of the time. Relaxation appears to be a consistent method of reducing stress. Although the relaxation technique is preferred more by women that by men, it is effective with both sexes.

Adult↗